Open House Registration Form
Please note that open houses may have limited space. We will be in contact if your desired open house date is full.
The open houses are every other Tuesday at our birth center. What date are you planning on attending?
Partner's Name (if attending with you)
Estimated Due Date
Address: 360 S Fort Ln #1B, Layton, UT 84041
Please arrive between 5 and 5:30 pm to meet the midwives and tour the birth center. From 5:30-6:30 pm, there will be an open forum for questions. If no attendees arrive before 5:30 pm, the open house for that night will conclude. ** Due to space constraints and concerns about social distancing, children will not be able to attend our open houses at this time.**
Due to COVID-19, please do not attend if you or someone in your family are experiencing shortness of breath, fever, cough, sore throat, etc.
Do you have any symptoms like fever, cough, sore throat, shortness of breath,or difficulty breathing?
Have you, in the past 14 days, traveled from an area with active COVID-19 community spread? *See
Have you been around someone who is showing symptoms like fever, cough, sore throat, shortness of breath,or difficulty breathing?
Please fill out our insurance verification form if you have an insurance plan that you may want to use for your birth.
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of miraclemidwifery.com.