Welcome Family Registration Form Please complete the following information to register for Welcome Family: "*" indicates required fields Caregiver Name* First Last City/Town residence, Massachusetts only*Cell Phone*Is an interpreter needed?* Yes No Preferred Language* Arabic ASL Chinese English Haitian Creole Portuguese Russian Spanish Vietnamese Other Do you have hypertension and/or preeclampsia?* Yes No Unsure Baby's Date of Birth Where did you hear about us? (check all that apply) Baystate Medical Center Community Health Center Caregiver Medical Provider (primary, OB/GYN, midwife) Pediatrician Home Visiting Service (EI, Healthy Families, Parents as Teachers, EIPP) WIC Friend or Relative Welcome Family Text Other Other
