River Valley Birth Center Orientation Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If you are interested in starting care with River Valley Birth Center or are just interested in learning more about the care we offer, the first step is to attend an orientation session. These sessions are held virtually via Zoom. We request that people mute their microphones, but feel free to have your camera on as it is lovely to get to see some faces as we cover the information and help you decide if birth center care is right for you!

After you register on this form, you will get an email confirming your registration. Stay on the look out for an email invite to the Zoom meeting, typically we send those out just a few hours before the start time.

While we require contact information for each registrant, we will not sell or share you information. We also will not add anyone to mailing lists or hassle you in any way! We want for you to be able to find out about our practice and services without any pressure or obligations.

Questions? Contact us at (507)934-1565

Email *

Name (first and last) *

Cell phone number (in the event we must cancel) *

Home or mailing address

Due Date (it is ok to estimate) *

Where did you hear about us?

Are there any specific topics or questions you are hoping we will cover during this session?

We have information we send to families regarding insurance and billing, depending on your coverage. In order to serve you best with the relevant forms, it is helpful if you don't mind sharing this information with us in advance. *

Commercial Health Insurance- Insurance through work, self-purchased, a spouse, or parent.

Minnesota Health Care Plans- Medicaid including BluePlus, UCare, South Country Health Alliance, or straight Medicaid through the state.

Tricare

VA insurance

Health Share- Examples include: Samaritan Ministries, Medi-share, Liberty Health Share, Christian Health, etc.

Self pay. I have no insurance or health share and do not intend to get coverage prior to the birth. I do not qualify for state insurance such as Medicaid.

Not sure/prefer to not disclose

Other:

Which orientation date will you attend? *

Thursday, June 16, 6:00PM

Thursday, June 30, 6:00PM

Thursday, July 14, 6:00PM

Thursday, July 28th, 6:00PM

I need assistance scheduling due to obligations that cannot be adjusted.

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of River Valley Birth Center. Report Abuse

Forms