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Register for Maternal and Child Health Services

Complete the form below to register for Maternal and Child Health Services. Once you have submitted the form, a member of our friendly MCH team will be in touch.

Parent One

First name

Last name

Date of birth

Contact number

Email address

Parent Two

First name

Last name

Date of birth

Contact number

Email address 2

Child's details

Child's name

Please upload a photo of where your infant is sleeping.

Hospital Discharge Summary

Please ensure each page of your hospital discharge summary is uploaded.

Please upload a copy of your hospital discharge summary. You may select and upload multiple documents here.

Agreement

I understand that my details and documentation will be reviewed by Maternal and Child Health staff members and added to my child's Merri-bek City Council health record.

Please read the Pr ivacy Fact Sheet (DOC 460Kb)

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