Labor and Delivery Pre-Registration Form

 If you have any questions while filling out this form, please call our Admitting office at (650) 497-8229, which is available 24/7. An asterisk (*) indicates that the information is required.

Please complete your pre-registration at least 6 weeks before your due date. There are 2 parts to pre-registration. Here is what to expect in this process: 

Part 1    

Fill out the online form. This should take about 30 minutes to fill out. Your information will only be saved at the end when you click submit.

Have the following information ready before you start.            

  • Mother's information, including employment and insurance
  • Father's/partner's information, including employment and insurance
  • Pregnancy information, including due date
  • Name of your baby's Pediatrician or clinic
  • Preferred pharmacy name and location
  • Emergency contact. This can be the father/partner

Part 2

To complete Part 2 of your pre-registration, you'll need to send in copies of the required cards listed below, as well as print, sign, and send in the forms linked below. There will be detailed instructions on how to complete the forms after the online submission (Part 1) is complete.         

  • Mother's Photo ID
  • Mother's Insurance Card
  • Father's/Partner's insurance card (if applicable)
  • Mother's Prescription Card
  • Required Forms (Click here to view or print the forms)
    • Acknowledgement of Notice of Privacy Practices
    • Permission to Call Mobile
    • Online Access to your Child's MyChart Account
    • Terms & Conditions of Service
    • Outpatient Terms & Conditions of Service
    • Advance Directive Status
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