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Labor & Delivery

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Pregnancy & Parenting E-Newsletter

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Labor & Delivery Pre-Registration Form

Please note your insurance plan may require a co-payment, co-insurance or deductible. Your payment will be requested at the time of your visit. Rex Healthcare accepts cash, personal checks and most major credit cards.
* Denotes required fields

General Information

Expectant Mother's Information

Employer's Information

Guarantor's Information

* Guarantor (Person Financially Responsible)
* Gender

Emergency Contact Information

General Care Information

* Are you enrolled in a Hospice Program?

Pregnancy and Parenting Classes

Explore our catalog of classes designed to help you with all aspects of pregnancy, delivery and returning to life at home. Register for a class today!

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