HCMC Prenatal Classes Registration Form

Haga clic aquí para registrarse en Español

  (Fill out 1 form per class)
* = required field
*First Name  
*Last Name  
*Zip Code
*Language Requirement
Other language, if applicable
*Primary Phone
Current HCMC Patient?
For your prenatal care, who do you see?  
Your Clinic Name  
Is this your  
first baby?  
Due Date  
* Prenatal class 
name desired  

Looking for Infant and Child CPR? Register here.

*Prenatal Class  
date desired 

Hennepin Heath and Medica MA members will receive a free car seat. Check with us to see if you qualify.
*Insurance Company**

**We bill insurance for the cost of most classes.

If you do not want us to bill your insurance, or you registered for the Big Brother/Big Sister or Clothing Diapering and Babywearing classes (for which we do not bill insurance), please bring cash, money order, or check payable to Hennepin County Medical Center to the class.

*Group Number
*Subscriber/Insurance Number

Thank you for completing this form!

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