Our Doctors FAQs Find Us Contact Us Medical Links Office Information Insurance Information Visit Registration Patient Education Initial/Annual Visit Or Consultation Form Prenatal Genetic Screening Options navigation bar  

Registration Form

Step 1: Enter Information > Step 2: Submit/Print > Step 3: Submitted

Please use this form to register for Richmond OB-Gyn's Prepared Childbirth classes. You should register for your class at approximately 20 - 24 weeks of your pregnancy.

Name
Coach’s Name

Coach’s relationship to you

Address

Home phone

Work phone

Due Date

Doctor

Is this your first baby? Yes    No

If not, what are the ages of your other children?

Classes are offered Monday & Wednesday evenings and Saturday mornings. Assignments will be made based on your due date. Please state if you have a specific conflict with any of these class times:

Your reservation will be confirmed when payment is received. At approximately 20 - 24 weeks of your pregnancy, submit this form and mail in your payment made payable to:

Richmond OB-Gyn Associates
Attn: Prepared Childbirth
1 Park West Circle, Suite 202
Midlothian, VA 23114

You may also print this form, fill it in, and place it and your payment in an envelope marked "Attention: Prepared Childbirth" and give to the front desk secretary at your visit.

Home page   Our doctors   FAQs   Insurance info   Find us   Office info   Contact us  
Medical links   Office Visit Registration Form   Notice of Privacy Practices
Patient Education   Prepared Childbirth Registration Form   Administrative Office  
Initial/Annual Visit Form   Prenatal Genetic Screening Options    
 
Copyright © 2007 by Richmond OB-Gyn Associates
Contact the webmaster |  Web page by Clients2You