Baby Consultation Questionnaire

Important: Mother's Insurance Information

Please note: Newborn babies are typically covered under the mother's insurance policy for the first 30 days of life. This is why we collect the mother's name and date of birth in the section above.

We will use the mother's information provided above to:

• Process insurance claims for your newborn's first 30 days
• Verify coverage and benefits
• Coordinate care with your insurance provider

After 30 days, your baby will need to be added to your insurance policy as a dependent. Please contact your insurance provider to complete this process.