Educational Class Request

Please fill out the form below for the class you are requesting. Thank you!

Name Name First Last
Date of Birth Date of Birth / MM / DD YYYY
Have you ever been a Soundview Pregnancy or Clearview Medical patient/client?

Have you ever been a Soundview Pregnancy or Clearview Medical patient/client? Yes No
Estimated Due Date Estimated Due Date / MM / DD YYYY
Preferred method of contact

Preferred method of contact Cell Phone Email
Cell Phone Cell Phone - ### - ### ####
Email
Disclaimer
Text/Chatbox/Email We are committed to protecting your health information. Please be aware that communicating via unencrypted electronic methods such as texting, chat box, email, has some level of risk of being read by a 3rd party.
Please choose your Class Date and Time below:
Pregnancy Basics
Newborn Care
Are you comfortable taking a group zoom class?

Are you comfortable taking a group zoom class? Yes No
Would you like a text/email reminder of your class the day before or the day of your scheduled class

Would you like a text/email reminder of your class the day before or the day of your scheduled class Yes No
Additional Class Information
Thank You for registering! If you have requested, the day before or the day of class you will receive an email/text reminder of your scheduled class. Please arrive on time to class on time. We look forward to having a great time learning and discussing together! One of our educators will be reaching out to you for conformation. We're so excited to see you on zoom soon! Below you will find our zoom meeting information! Please save to your device and call our office if you need assistance. Thank you! https://zoom.us/j/2493331494?pwd=VG01c3EzdlNoVXdyaTJramFuWXJkZz09

Educational Class Request

Educational Class Request

Please choose your Class Date and Time below: