Labor and Delivery Pre-Registration Form

Thank you for choosing Lucile Packard Children’s Hospital Stanford for your labor and delivery and maternity care.

If you have any questions while filling out this form, please call our Admitting Office at (650) 497-8229. They are available 24 hours a day, 7 days a week. An asterisk (*) next to the question indicates that the information is required.

Please complete your preregistration at least six weeks before your due date. There are two parts to preregistration. Here is what to expect in this process:

Part 1    

Fill out the online form. This should take about 30 minutes. Your information will be saved at the end only when you click “Submit.”

Have the following information ready before you start.

• Mother’s information, including employment and insurance.
• Father’s or partner’s information, including employment and insurance.
• Pregnancy information, including due date.
• Name of your baby’s pediatrician or clinic.
• Preferred pharmacy name and location.
• Emergency contact. This can be the father or partner.

Part 2

To complete Part 2 of your preregistration, you will need to send in copies of the required cards listed below. You will also need to print, sign, and send in the forms linked below. There will be detailed instructions on how to complete the forms after the online submission, Part 1, is complete.

• Mother’s photo ID.
• Mother’s insurance card.
• Father’s or partner’s insurance card, if applicable.
• Mother’s prescription card.
• Required Forms (Click here to view or print the forms)
  • Acknowledgment of Notice of Privacy Practices
  • Permission to Call Mobile Phone
  • MyChart Proxy Access Request (online access to your child’s MyChart account)
  • Terms and Conditions of Service
  • Outpatient Terms and Conditions of Service
  • Advance Directive Status

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