Book your place

To register for our next open evening, please fill in the patient details on the form below.

You will receive a confirmation email to acknowledge your registration.

Please select which session you would like to attend:

Thursday 23rd May, 17:45-19:45

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Please include your prefix.

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Please include your first name

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Please include your surname

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Please include your email

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Please include your phone number

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Please include your postcode

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Is this your first pregancy?

Yes

No

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Please enter a valid date and time

What is your delivery due date?

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Are you booked to have a baby at The Portland?

Yes

No

Considering

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Are you happy for us to contact you to discuss your answers?

Yes

No

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How would you prefer to be contacted?

Phone

Email

Both

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Are you happy to receive further information from The Portland Hospital? By checking 'yes' this box you are confirming that you would like to receive more information on our services, news and events.

Yes

No

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How did you hear about the Pregnancy Open Evening?

Enquiry Email

Maternity Enquiry Line

Portland Staff Member

The Portland Website

Other

If other please state here:

Thank you for completing The Portland Pregnancy Open Evening's Registration.

HCA International Limited. Registered number: 03020522. A Company Registered in England and Wales.

Registered office: 2 Cavendish Square, London, W1G 0PU

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