HealthAlliance Hospital
Labor & Delivery
Birthing Tour
Visita de partos
Personal Information (
Información personal
)
First Name
Primer nombre
Last Name
Apellido
Date of Birth
Fecha de nacimiento
Personal E-mail
Correo electrónico personal
Phone Number
Número de teléfono
Due Date
¿Cuál es la fecha de parto?
To ensure availability for all tours, we recommend the tour between weeks 30 and 34 of pregnancy
Para garantizar la disponibilidad de todas las visitas, recomendamos hacer la visita entre las semanas 30 y 34 de embarazo
Who is your OBGYN or Midwife?
¿Quién es su ginecólogo o matrona?
Please select...
Keplinger, Kenneth B., MD
Sone, Vivian, MD
Davi, Dayna, NP
McPadden, Marion, CNM
Wagner, Elly, PA
Other
Please specify:
Especifíquelo
:
OBGYN or Midwife's Phone Number:
Número de teléfono del ginecólogo o partera
How did you hear about this tour?
¿Cómo se enteró de esta gira?
Please select...
Caregiver Center
Family member (miembro de la familia)
Online (en la red)
Primary Physician
Social media (redes sociales)
WMC website
Other
Please specify:
Especifíquelo:
Location
Ubicación
Please select...
HealthAlliance Hospital
Preferred Language
Idioma preferido
Please select...
English
Spanish
Other
Please specify
Especifíquelo
Chaplaincy Services during the tour
Servicios de capellanía durante el recorrido
Please select...
Imam
Pastor
Priest
Rabbi
Do not need chaplaincy services
Other
Please specify
Especifíquelo
Tour Date/Time
Fecha y hora de la visita
Please select...
Monday December 22- 6:00pm
Monday December 29- 6:00pm
Monday January 5-6:00pm
Wednesday January 7-6:00pm
Thursday January 8-6:00pm
Monday January 12-6:00pm
Wednesday January 14-6:00pm
Thursday January 15-6:00pm
Wednesday January 21-6:00pm
Thursday January 22-6:00pm
Monday January 26-6:00pm
Wednesday January 28-6:00pm
Thursday January 29-6:00pm
Monday February 2-6:00pm
Wednesday February 4-6:00pm
Thursday February 5-6:00pm
Monday February 9-6:00pm
Wednesday February 11-6:00pm
Thursday February 12-6:00pm
Wednesday February 18-6:00pm
Thursday February 19-6:00pm
Monday February 23-6:00pm
Wednesday February 25-6:00pm
Thursday February 26-6:00pm
Monday March 2-6:00pm
Wednesday March 4-6:00pm
Thursday March 5-6:00pm
Monday March 9-6:00pm
Wednesday March 11-6:00pm
Thursday March 12-6:00pm
Monday March 16-6:00pm
Wednesday March 18-6:00pm
Thursday March 19-6:00pm
Monday March 23-6:00pm
Wednesday March 25-6:00pm
Thursday March 26-6:00pm
Monday March 30-6:00pm
Wednesday April 16-6:00pm
Thursday April 2-6:00pm
Monday April 6-6:00pm
Wednesday April 8-6:00pm
Thursday April 9-6:00pm
Monday April 13-6:00pm
Wednesday April 15-6:00pm
Thursday April 16-6:00pm
Monday April 20-6:00pm
Wednesday April 22-6:00pm
Thursday April 23-6:00pm
Monday April 27-6:00pm
Wednesday April 29-6:00pm
Thursday April 30-6:00pm
Monday May 4-6:00pm
Wednesday May 6-6:00pm
Thursday May 7-6:00pm
Monday May 11-6:00pm
Wednesday May 13-6:00pm
Thursday May 14-6:00pm
Monday May 18-6:00pm
Wednesday May 20-6:00pm
Thursday May 21-6:00pm
Wednesday May 27-6:00pm
Thursday May 28-6:00pm
Monday June 1-6:00pm
Wednesday June 3-6:00pm
Thursday June 4-6:00pm
Monday June 8-6:00pm
Wednesday June 10-6:00pm
Thursday June 11-6:00pm
Monday June 15-6:00pm
Wednesday June 17-6:00pm
Thursday June 18-6:00pm
Monday June 22-6:00pm
Wednesday June 24-6:00pm
Thursday June 25-6:00pm
Monday June 29-6:00pm
Will you bring a support person?
¿Traerá a una persona de apoyo?
Yes (Sí)
No
Who will be joining you? (
¿Quién le acompañará?
)
First name
Primer nombre
Last name
Apellido
Relationship to you
Relación con usted
Contact Information