WJMC - West Jefferson Medical Center

WJMC - West Jefferson Medical Center


WJMC Family Birth Place Class Sign Up

 

Family Birth Place
Class Sign-up


 
Please click HERE for info on the classes offered.

 

 
  First name Last name
  Name:
 

 

 
  Date of Birth:

 
  Best number to reach you
  Contact
  Phone:

 
  Alternate number to reach you
  Secondary
  Phone:

 
  Email
  Address:
 
 

 
  Please choose
  which class
  you want to
  sign up for:
   



 
  Listed below are the class dates and last day to sign up for each class. If you don't see the date for your class that you were looking for, contact Pam at 504.349.6200 for alternate arrangements
  Please choose
  which date
  you want:



 
  Please skip this question for Mother-Daughter Rap or Babysitters class.
  Baby's due
  date?

 
  Please skip this question for Mother-Daughter Rap or Babysitters class.
  Do you have an
  OB/GYN
  doctor?
OB/GYN Doctor’s Name:

 
  Do you have a
  primary care
  doctor?
  Primary Care Doctor’s Name:

 
  Question is for marketing purposes only. All are welcome to attend class.
  Are you a
  current
  patient at
  West Jeff?
   

 


 

 

 
 
 

 



WJMC Pediatric Emergency