The Best for You and Your Baby

FOR HAWAII RESIDENTS. If you're expecting or planning to have a baby, and anticipate delivering on the island of Oahu, please complete the form below to receive your FREE "Having a Baby" Kit and $30.00 Gift Certificate. When you deliver at Kapi'olani, you can use this gift certificate toward Kapi'olani classes or to purchase special gifts and keepsakes from our hospital gift shops. Our staff may contact you later to offer assistance with registration for classes, our free tour, or hospital visit.

* Required Information

My Information
First Name:*
Last Name:*
Address:*
City:*
State:
Zip:*
E-mail:
Social Security Number:
Due Date:
My First delivery:	YesNo
My doctor's name:
I plan to deliver at:	Kapi`olani Undecided Other
Home Phone:
Work Phone:
Best Time to Call:
How did you hear about this online request page?   FlyerBrochure Visited site for maternity servicesVisted site for Babies On-Line Browsing on the InternetOther
Please send my friend a Baby Kit
My Friend's First Name:
My Friend's Last Name:
Address:
City:
State:
Zip:
Due Date:
First Delivery:	YesNo
Doctors Name:
Plans to deliver at:	Kapi`olani Undecided Other
Home Phone:
Work Phone: