Orientation

Which Orientation will you be attending?

Please pick a date so we know when to expect you. You will not receive a confirmation email after signing up. Our address is: 3101 Telegraph Ave. Berkeley 94705. If you do not use this zip code, maps might take you to the same address in Oakland.

Name

(first and last please)

First Name

Last Name

Partner Name

(if applicable)

First Name

Last Name

Email Address

Phone Number

(###)

###

####

Have you ever given birth before?

Please note: We are unable to provide care for people with a previous c-section seeking VBAC (a vaginal birth after a cesarean). We are also unable to provide midwifery care for people who are pregnant with twins.

Yes

What is your due month or estimated due date?

YYYY

If you carry health insurance, what type do you hold?

We are not able to accept MediCal at this time (Except some Alameda Alliance for Health (AAH) plans AND Berkeley SHIP through Wellfleet). We are not contracted with any insurance companies. Clients pay an upfront fee for care and if possible we bill the insurance company to obtain a retroactive reimbursement. We offer a sliding scale and payment plans if requested.

How did you hear about us?

Please tell us about any major health concerns that may affect your pregnancy. Including but not limited to any past C-sections

Note that there are certain health issues that may necessitate care with a different provider. We will contact you if there is a reason that we may not be able to provide you with care at Pacifica.

Orientation

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