University Hospitals - Cleveland

Pregnancy and Early Childhood Sign-up Form

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Angelina Gangestad, MD

Chief, General Obstetrics & Gynecology

As you prepare for childbirth and caring for your new baby, we want to touch base with you by email each week to make sure you have additional support on your journey into parenthood. We think this is the best way for us both to connect regularly.

This program is free, includes customized information, news and resources tailored to your specific stage of pregnancy and/or your child’s age—as well as announcements from our staff and access to support information—all conveniently delivered right to you!

This program is powered by UbiCare, a product of TPR Media LLC.


YOUR RIGHTS:

• You may refuse to sign this authorization.

• Refusal will not affect your ability to obtain treatment or your eligibility for benefits through your care provider.

• You may revoke this authorization at any time. Revocation will take effect immediately.

• You have a right to receive a copy of this authorization.

REMUNERATION:

By clicking “submit,” you acknowledge that your care provider will not disclose nor directly receive any money for the use of your health information provided for this program.