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Baby’s First Signup

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Congratulations! WellCare is very excited about your new baby and wants to help you with this new part of your lives.

As part of the WellCare Baby’s First program, we will send you 1 - 6 care messages/week via text until your baby is 15 months old. This does not replace your doctor’s care. Rather, it is meant as an extra helping hand.

To make sure we send you information on the postpartum and baby care topics that will help you and your baby most, we need to get to know you a little better. Please complete this quick survey to help us. The Baby’s First program was designed to help you, is completely voluntary and you may opt out at any time. Text messages will be part of your mobile carrier text plan. Your information will be completely private and will not be shared or used for any other purpose.

Please complete the form to join the program.

Mother's Name*
First Last
Mother's Date of Birth*
MM slash DD slash YYYY
Are you a WellCare member?*
- Yes
- No
WellCare Member ID
(if known)
Mobile Number*
The Baby’s First text care messages will come from phone number 52046. Message and data rates may apply according to your carrier text and data plan. You can opt out at any time by replying STOP to any message or you can get help with the Baby’s First program by replying HELP.
What type of mobile phone do you have?*
- Smartphone (e.g. iPhone, Android, Windows phone)
- Regular phone no data plan
Zip Code

When was your baby (or babies) born?*
MM slash DD slash YYYY
How many babies did you deliver?*
- 1 baby
- Twins
- Triplets
- Quadruplets
Baby's Name*
First Last
Is your baby a WellCare member?*
- Yes
- No
Baby's WellCare Member ID
(If known)
Baby 2
Baby's Name*
First Last
Is your baby a WellCare member?*
- Yes
- No
Baby's WellCare Member ID
(If known)
Baby 3
Baby's Name*
First Last
Is your baby a WellCare member?*
- Yes
- No
Baby's WellCare Member ID
(If known)
Baby 4
Baby's Name*
First Last
Is your baby a WellCare member?*
- Yes
- No
Baby's WellCare Member ID
(If known)

Questions
Is this your first child?*
- No
- Yes
Did you smoke, drink or take drugs during the pregnancy?*
- No
- Yes
Was your baby in the NICU after birth?*
- No
- Yes
What is your highest level of education?*
- Some high school
- High school diploma
- Some college
- College diploma
- Masters or higher
Is the baby’s father participating in raising your child?*
- No
- Yes
Do you need help with safe housing, financial assistance, heating, air conditioning, or water?*
- No
- Yes
Who else lives in your household? Check all that apply.*
- No one; I live alone with my baby
- My other children that I gave birth to
- Other children than mine (e.g. step children, brothers or sisters, etc.)
- Husband or boyfriend who is the baby’s father
- Husband or boyfriend who is NOT the baby’s father
- My parents
- Other family
- Other friends
Do you have a support group or family help in raising your child?*
- Lots of help and support
- Limited help and support
- No help or support
Do you ever feel like you may hurt yourself or your baby?*
- No
- Yes
Do you ever feel like your partner or someone else in your household may hurt your baby?*
- No
- Yes
HIPAA Waiver / Terms & Conditions*
- I have read and agree to the HIPAA Waiver and Terms & Conditions for this program.
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HighStep1
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LowRiskW
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LowRiskC
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MultipleW
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MultipleC
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DaysCalc
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Date
MM slash DD slash YYYY
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Age
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Hurt Baby YES
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NicuEmail
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HurtEmail
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CID

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