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 class (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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