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Prenatal Class Registration-First Time Participant
Please tell us a little about you so that we can be prepared to best meet your individual needs.
Baby's Due Date
What languages do you speak?
Have you been pregnant before?
Do you have experience caring for infants?
I have other children
I have other experience (babysitting, step-parenting, etc.)
Do you have a partner you've lived with for more than 2 years?
Where do you go for regular health care (not related to pregnancy)?
Your health care provider's office
The emergency room
I don't get regular health care
Do you have a health care provider for pregnancy care?
Yes (please list name next to "other" below)
No, I need assistance with locating a provider for prenatal care
Do you have health insurance?
Are you currently employed?
I work full-time
I work part-time
I'm looking for work
Where do you get most of your information about pregnancy?
Friends and family
My health care provider
Books and magazines
Do you have any worries or concerns about pregnancy?
How did you hear about this class?
Sarpy County Cooperative Head Start
Cass County Early Childhood
Sarpy/Cass Health Department Website
Sarpy/Cass Health Department Facebook Page
A copy of your responses will be emailed to the address you provided.
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