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STATE OF ETERNIA
Patient Intake Form

Must be completed after attending a consultation with OWMC staff.

 

SECTION I - PATIENT INFORMATION

The information in this section is gathered to assist us in identifying appropriate care for you and your little one--the patients of Oceanside Wellness & Maternity Center. Keep a copy of the completed form for your records. Any changes to this form should be provided upon patients' arrival. Please provide complete information so that health personnel can be aware of the needs of you and your bundle of joy.

SECTION II - ATTENDEES  / EMERGENCY CONTACT(S) INFORMATION

 

We kindly request the information below to ensure that we can make appropriate accommodations for the number of parents/family members joining you on the incredible journey of childbirth at Oceanside Wellness & Maternity Center. Knowing the number of parents, family members, and friends attending your appointments allows us to prepare and arrange the necessary facilities and resources to support your experience with utmost care and comfort. Additionally, we may use this information to obtain emergency contacts for you, ensuring that we have a reliable point of contact in case of any unforeseen circumstances during your stay. Your cooperation in providing this information is greatly appreciated, and we are dedicated to providing exceptional care throughout your childbirth journey.

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