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Personal Details - Step 1 of 6

First name *

Last name *

Date of birth *

Nationality *Please selectSwitzerlandGermanyAustriaAfghanistanEgyptAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaEquatorial GuineaArgentinaArmeniaAzerbaijanEthiopiaAustraliaBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiChileChinaCosta RicaDenmarkDominicaDominican RepublicDjiboutiEcuadorEl SalvadorIvory CoastEritreaEstoniaEswatiniFijiFinlandFranceGabonGambiaGeorgiaGhanaGrenadaGreeceGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasIndiaIndonesiaIraqIranIrelandIcelandIsraelItalyJamaicaJapanYemenJordanCambodiaCameroonCanadaCape VerdeKazakhstanQatarKenyaKyrgyzstanKiribatiColombiaComorosDemocratic Republic of the CongoRepublic of the CongoCroatiaCubaKuwaitLaosLesothoLatviaLebanonLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMoroccoMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMozambiqueMyanmarNamibiaNauruNepalNew ZealandNicaraguaNetherlandsNigerNigeriaNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalRwandaRomaniaRussiaZambiaSamoaSan MarinoSão Tomé and PríncipeSaudi ArabiaSwedenSenegalSerbiaSeychellesSierra LeoneZimbabweSingaporeSlovakiaSloveniaSomaliaSpainSri LankaSt. Kitts and NevisSt. LuciaSt. Vincent and the GrenadinesSouth AfricaSudanSouth SudanSurinameSyriaTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoChadCzech RepublicTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineHungaryUruguayUzbekistanVanuatuVatican CityVenezuelaUnited Arab EmiratesUnited KingdomUnited StatesVietnamBelarusWestern SaharaCentral African RepublicCyprus

OASI number *

Marital status *Please selectmarriedsinglein a registered partnershipdivorcedwidowed

First and last name of partner

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Address *

Postcode *

Location *

Email *

Phone *

we Phone Layout

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Care for *

• Pregnancy
• Home birth
• Birth with an attending midwife
• Postpartum

Estimated due date

Planned place of birth

Which pregnancy

(incl. current)

Do you already have children?

• Yes
• No

Child(ren)

First name

Last name

Date of birth

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Blood group and Rhesus factor *Please selectA+A-B+B-AB+AB-0+0-

of the expectant mother

Your health insurance *

Gynecologist *

Pediatrician

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Employment *

• Employed or self-employed
• Homemaker

Occupation *

Workload in % *

Resumption of external employment

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Where can we park at your place? *

How did you hear about us? *

Comments

Acknowledgment *

• I acknowledge that my registration becomes binding upon submitting the form.*

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