Preregister for the Centre for Family Beginnings
Please print clearly and fill in all spaces. If something does not apply to you, place an “N/A” in the space provided. Incomplete forms cannot be processed. Thank you.
Register Online by clicking here.
or
Please Mail To: Wellington Regional Medical Center Attn: Admitting Office 10101 Forest Hill Boulevard Wellington, FL 33414
Download a PDF of the preregistration form.
or
Register in Person: The Admitting Office Wellington Regional Medical Center Monday—Friday 7 a.m. - 4 p.m.
Florida Birth-Related Neurological Injury Compensation Association (NICA)
In order to fully process your preregistration, please download the NICA pamphlet and form. The form must be signed and returned to:
Wellington Regional Medical Center Attn: Admitting Office 10101 Forest Hill Boulevard Wellington, FL 33414
NICA Pamphlet
NICA Consent Form
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