Registration - Geburtshaus Zürcher Oberland

As a pregnant woman, you can use this form to register with us if you:

Have attended one of our information events (held in German)
Have had a private tour
Have already given birth at the birthing centre
Spent the postnatal period in the birthing centre after giving birth at home or in hospital

Please complete the form before the admissions interview – thank you!

Registration at the birthing centre *

Surname *

First name *

Date of birth *

Street house number (place of residence) *

Postcode town/city (place of residence) *

Telephone *

E-mail address *

Surname/first name of partner

Nationality of partner

Profession of partner

Cellphone of partner

Marital status *

Nationality *

AHV no. *

Name of health insurer (basic health insurance) *

Basic health insurance card number (20 figures) *

Insurance number basic health insurance *

Expiry date of basic health insurance card *

Type of insurance *

Name/Surname of current gynecologist

Address/ZIP/City of current gynecologist

Calculated due date

Date of information event/private tour attended on

Last birth at the birthing centre

Last postnatal stay at the birthing centre after a home or hospital birth

Admissions interview already arranged *

If so, when?

Additional notes:

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