RTC Pediatrics Prenatal Class Registration
Please select 1 of the following Class Dates:
12/17 6:30 pm with Dr. Howard
1/7/2025 6:30 pm with Dr. Howard
1/21/2025 6:00 pm with Dr. Powers
2/5/2025 6:00 pm with Dr. Susco
2/19/2025 6:00 pm with Dr. Hossain
3/4/2025 6:30 pm Virtual Class with Dr. Fleming. A virtual link will be sent to you the day before the class.
3/18/2025 6:30 pm with Dr. Howard
Mother's Name:
First Name
Last Name
Partner's Name:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
FULL NAME of Insurance Plan that your newborn will be added to:
Is this a PPO or an HMO plan?
Was this insurance plan obtained through your job or purchased through the state/marketplace/exchange? Please indicate below:
through job/employer
purchased through the Exchange/Marketplace
Due Date:
-
Month
-
Day
Year
Date
Delivery Hospital:
How did you hear about our practice?
Submit
Should be Empty: