Registration Form

Personal Details

Please enter your full name. Please enter your NHI number. Please enter your full postal address. Please enter your daytime phone number. Please enter your evening phone number. Please enter your email. The email you have entered is invalid. Please enter your date of birth. Please enter the country where you were born.

Birthcare Service Selection

Please refer to our schedule of charges for full pricing information as you must meet certain criteria for our free services.

Are you an NZ Resident?


Please select if you are an NZ Resident Birthcare Options for NZ Residents
NOTE: Birthcare only provides facilities for normal labour and Birth. Room Options (conditions apply, please see our schedule of charges)


 Birthcare Options for non NZ Residents (select all that apply)
NOTE: Birthcare only provides facilities for normal labour and Birth.

A value is required.

Schedule of Charges


Please tick to show you have read the Schedule of Charges

Lead Maternity Career

Please enter your LMC's name. Please enter your LMC's title. A value is required.
Please enter your expected date. Please enter your proposed place of delivery. Please enter your gravida. Please enter your parity.

Next of Kin or Contact Person

Please enter their name. Please enter your relationship. Please enter their kins phone number. Please enter their evening number. Please enter their address.

Code of Rights

Please tick to show you have read the Code of Rights