For deliveries at Newton Medical Center, please fill out the secure HIPAA-compliant form below. This form does not auto-save. Do not refresh.

You can also opt for the fillable PDF baby pre-registration form.

Our providers are the only pediatricians with credentials at the NMC hospital. The mother’s provider will indicate if we are requested at the delivery. We will see your baby within the first 24 hours and order required labs.

After dismissal, your baby will need to be seen within two weeks by your baby’s follow-up doctor.

Baby Pre-Registration - for newborns to be seen at Cottonwood Pediatrics (Newton, KS) or born at Newton Medical Center

If policyholder is not a parent listed on this form, please fill out the following:

If policyholder is not a parent listed on this form, please fill out the following: