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*
ie. Dr. Lastname
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*
ie. Dr. Lastname
Office Location*
ie. Trinity Medical OB/GYN
Payment Information

Please check one
I authorize Catholic Heath to bill my insuranceI do not authorize Catholic Heath to bill my insurance
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*
Choose Your Classes
Visit chsbuffalo.org/childbirth-classes for available dates and times.
Select the Classes*

Prepared Childbirth - BasicsPrepared Childbirth - ActivityLamaze FocusPrepared CaesareanPrenatal YogaPrepared PartnersGestational DiabetesStrong Family PlanningMultiple MiraclesNICU/Higher RiskBreastfeedingGrandparentsInfant & Child CPRCar Seat SafetyBaby TalkHealing After BirthHospital Tours
Childbirth Classes

Active Comfort Techniques for LaborBaby & Me YogaComprehensive ChildbirthHospital ToursLamaze FocusPrenatal YogaPrepared Cesarean DeliveryPrepared Childbirth - ActivityPrepared Childbirth - BasicsPrepared Partner
Classes for Baby Care and Family Safety

Baby TalkBreastfeedingCar Seat SafetyInfant & Child CPR
Specialty Classes

Gestational DiabetesGrandparentsHealing After BirthMultiple MiraclesNatural Family PlanningNICU/Higher Risk Moms & BabiesStrong Family Foundations
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/yoga/ to view the upcoming class schedule, and enter your preferences below.
Baby & Me Yoga - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Baby & Me Yoga - 2nd Choice

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

MonthDayYear
Date
Hour MinutesAM/PM Option
Comprehensive Childbirth - 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
Visit https://www.chsbuffalo.org/childbirth-classes/childbirth-education-series/ 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/yoga/ to view the upcoming class schedule, and enter your preferences below.
Prenatal Yoga - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prenatal Yoga - 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 Delivery - 1st Choice

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

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

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

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

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Childbirth - Basics - 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 Partners - 1st Choice

MonthDayYear
Date
Hour MinutesAM/PM Option
Prepared Partners - 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/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/child-safety-classes/ 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/child-safety-classes/ 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/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/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/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/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/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/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/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
Additional Comments
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Childbirth Class Registration

Payment Information

Choose Your Classes