Orientation Sign Up – Brooklyn Birthing Center

Orientation of Brooklyn Birthing Center

All Orientation sessions are held by ZOOM session only. You will receive a confirmation email for Orientation with the Zoom link on or before the day of Orientation. Please check spam folder for the orientation link as sometimes it goes there instead of the inbox. We accept transfers up to 36 weeks of pregnancy, but only if approved by the Clinical Team that you are healthy and low risk. Please note that we do not accept pregnant people who have had a previous cesarean section or presently pregnant with twins.

Appointment Time

Select Time*

Name*

First Last

Date of Birth

Your Partner or Spouse's Name

Contact Information

Address

Street Address Address Line 2 City State ZIP Code

Phone*

We use this number to contact you about your appointments and health information. Please advise any alternative number of contact to the office personnel.

Alternate Phone

We may use this number to contact you about your appointments and health information. If you have any concerns, please speak to our office staff .

Email*

Enter Email Confirm Email

You will receive a confirmation notice at this e-mail address. If you receive care at Brooklyn Birthing Center or Jazz Birth Center, you may receive an occasional e-mail notification.

Insurance

Do you have insurance coverage?*

Yes
No

If you have insurance, what is your plan called*

Please be as specific as possible, as many insurance companies offer multiple plans.(PPO, HMO, SharePlan, Essential, Gold, Silver, etc.)

Medicaid Managed Care Plan*

Yes
No

Do you have coverage through a Medicaid Managed Care Organization?

Are you applying for Medicaid at this time?

Yes
No

Pregnancy

Are you currently pregnant?*

Yes
No

If not, are you planning a pregnancy?

Yes
No

Please indicate the number of previous births?*

If you have given birth in the past, where did you deliver?

If you had a cesarean section?*

Yes
No

Our protocols do not allow attempting labor after a cesarean section in the birth center. Feel free to contact us if you need a assistance in a referral.

What is your estimated due date?*

Have you already received prenatal care for this pregnancy?*

Yes
No

If you have had any prior care for this pregnancy, you will be asked to send in your medical records for review.

Additional Information

How did you learn about Brooklyn Birthing Center? (Check all that apply)

Note: If at all possible, please bring anyone else who may be part of your decision-making process. Partners, family members (including children), and labor support team members are welcome.

If you have any questions, or if you need to reschedule your orientation, please call the main office at 718-336-4119.

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