Pre-Admission Registration

Our UCLA Health admissions office offers two options for registration before you come to the hospital, so that you can focus on the joy of your special moment. We encourage you to register for your delivery using: 

• Option 1: Online through myUCLAhealth
• Option 2: Pre-Admission form. Complete and return the Pre-Admission form below as soon as possible during your pregnancy.

If you are completing and returning the Pre-Admission form, please also read and sign the Condition of Services forms - one for you and one for your baby. Please also complete the other steps in the Pre-Admission Checklist below. 

Once we receive your online request for delivery or completed forms, we enter your information into our computer-system and contact your insurance company for verification. 

When your doctors office instructs you to come to a UCLA hospital after labor begins, please go straight to the Labor & Delivery Unit. Remember to bring your insurance card with you.

Pre-Admission Checklist

Select one of the options for registration below. 

Option 1 - through myUCLAhealth

To register your delivery using myUCLAhealth, please follow all of the steps listed below:

1. When you are logged into your myUCLAhealth account, you can click on the Menu button, and find Register for My Delivery.
2. Enter your expected due date if it is not listed, and select the hospital where you plan to give birth.
3. Click Continue.
4. Verify or update your Personal Information, Insurance Information, and appointment-related Questionnaires.
5. Review your responses, and click Submit.

Option 2 - by Pre-Admission form

To complete the pre-admission process, please follow all of the steps listed below:

1. Print and complete the Pre-Admission Registration form (see below). If you have not yet chosen a pediatrician for your baby, please write (to be decided) in the space after "Pediatrician."
2. Print and complete two Terms and Conditions of Service forms -- one for you, and one for your baby -- and sign them. (If you're expecting multiples, you must complete a form for each baby.)  For the "Relationship of Representative to Patient" section underneath the signature, write "Self" on your form, and "Mother" on baby's form.
3. Before completing the section about "Advance Directives" on the Terms and Conditions of Service forms, please read the "Patient Rights and Responsibilities" section of our website and the document below titled "Your Right to Make Decisions about Medical Treatment."   It will help you better understand and answer the questions in this section.
4. Do not complete the "Advance Directives" section on your baby's form. Draw a line through it and write "Minor".
5. Mail all of the above documents with your insurance form or a copy of your insurance card (both sides) to: 
   UCLA Santa Monica Medical Center and Orthopeadic Hospital
   Admissions Office, Suite G314
   1250 16th Street
   Santa Monica, CA 90404
6. If you have a completed Advance Directive, please include a copy with these forms.
7. Mail completed forms at least 2 months before your due date.

Please note: We don’t accept faxed copies of the terms and conditions of service form, as original signatures are required.

* For a brochure with more information about advance directives, or the actual form, please call the Admissions office at 424-259-6727.  
* Sign up for a myUCLAhealth account

Need help using myUCLAhealth?
Call our 24/7 Patient Help Desk anytime at 855-364-7052 or email [email protected].

Pre-Admission Forms - Available in English and Spanish

Pre-Admission Form (Please print and complete in full) 

Formulario Pre-Internacion (Por favor, complete todo el formulario con letra de molde) 

Notice of Privacy Practices in English 

Aviso de Practicas de Privacidad 

Terms and Conditions of Service - Available in English (PDF) and Spanish (PDF) (Please print all pages and complete in full)

Your Right to Make Decisions About Medical Treatment - Available in English (PDF) and Spanish (PDF)