Childbirth Class Registration

Childbirth Class Registration
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last 4 digits of SSN*
Martial Status*
Race*
Ethnicity*
Religion*
Employer*
Emergency Name and Phone*
Primary Physician*
Office Location*
Are You an Expectant Mother?*

YesNo
Where do you plan on delivering?*

Sisters of Charity HospitalMercy Hospital of BuffaloOther
Previous Maiden Name*
Due Date*

MonthDayYear
Date
Date of Last Menstrual Period*

MonthDayYear
Date
OB Provider's Name*
Office Location*
Payment Information

Please check one
I authorize Catholic Heath to bill my insuranceI do not authorize Catholic Heath to bill my insurance (signature required)
Primary Insurance*
Policy Number*
Subscriber*
Subscriber's Employer*
Subscriber's Date of Birth*

MonthDayYear
Date
Subscriber's Relationship to Patient*
Group*
Plan*
Secondary Insurance*
Policy Number*
Medicare Number*
Medicaid Number*
Newborn Medicaid Number*
Signature*

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Choose Your Classes
Visit chsbuffalo.org/childbirth-classes for available dates and times.
Select the Classes*

Prepared PregnancyChildbirth - BasicsChildbirth - ActivityLamaze FocusPrepared CaesareanActive Comfort Techniques for LaborPrepared PartnerNatural Family PlanningGestational DiabetesStrong Family PlanningMultiple MiraclesNICU/Higher RiskBreastfeedingGrandparentsInfant & Child CPRCar Seat SafetyBaby TalkHealing After BirthHospital Tours
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-pregnancy-class/ to view the upcoming class schedule, and enter your preferences below.
Prepared Pregnancy - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Pregnancy - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-childbirth-basics-class/ to view the upcoming class schedule, and enter your preferences below.
Childbirth - Basics - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Childbirth - Basics - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-childbirth-activity-class/ to view the upcoming class schedule, and enter your preferences below.
Childbirth - Activity- 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Childbirth - Activity- 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/lamaze-focus-class/ to view the upcoming class schedule, and enter your preferences below.
Lamaze Focus - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Lamaze Focus - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-cesarean-delivery-class/ to view the upcoming class schedule, and enter your preferences below.
Prepared Caesarean - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Caesarean - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/active-comfort-techniques-for-labor-class/ to view the upcoming class schedule, and enter your preferences below.
Active Comfort Techniques for Labor - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Active Comfort Techniques for Labor - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/prepared-partners-class/ to view the upcoming class schedule, and enter your preferences below.
Prepared Partner - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Partner - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/natural-family-planning-class/ to view the upcoming class schedule, and enter your preferences below.
Natural Family Planning - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Natural Family Planning - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/gestational-diabetes-class/ to view the upcoming class schedule, and enter your preferences below.
Gestational Diabetes - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Gestational Diabetes - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/strong-family-foundations-class/ to view the upcoming class schedule, and enter your preferences below.
Strong Family Foundations- 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Strong Family Foundations- 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/multiple-miracles-class/ to view the upcoming class schedule, and enter your preferences below.
Multiple Miracles - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Multiple Miracles - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/nicu-higher-risk-moms-babies-class/ to view the upcoming class schedule, and enter your preferences below.
NICU/Higher Risk- 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
NICU/Higher Risk- 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/breastfeeding-class/ to view the upcoming class schedule, and enter your preferences below.
Breastfeeding - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Breastfeeding - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/grandparents-class/ to view the upcoming class schedule, and enter your preferences below.
Grandparents - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Grandparents - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/infant-child-cpr-class/ to view the upcoming class schedule, and enter your preferences below.
Infant and Child CPR - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Infant and Child CPR - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/car-seat-safety-class/ to view the upcoming class schedule, and enter your preferences below.
Car Seat Safety - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Car Seat Safety - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/baby-talk-class/ to view the upcoming class schedule, and enter your preferences below.
Baby Talk - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Baby Talk - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/healing-after-birth-class/ to view the upcoming class schedule, and enter your preferences below.
Healing After Birth - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Healing After Birth - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Visit https://www.chsbuffalo.org/childbirth-classes/hospital-tours/ to view the upcoming class schedule, and enter your preferences below. Prepared Childbirth classes offer an optional hospital tour. There is no need to request a hospital tour if you are registering for the Prepared Childbirth class.
Hospital Tour - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Hospital Tour - 2nd Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
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Childbirth Class Registration

Payment Information

Choose Your Classes