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Birth Certificate Registration Form

If you are coming to Women's Hospital to have your baby, we strongly encourage you to fill out our online birth certificate registration form to save you some paperwork once you are at the hospital.

The State of North Carolina Vital Records office requires the following questions be answered to complete your child’s birth certificate. The birth certificate is a legal document that proves your child’s age, citizenship and parentage; therefore, it is very important you provide complete and accurate responses to all of the questions below.

* Denotes required fields

Contact Information

Child's Information

* Have You Determined Baby's Legal Name?
* Do you want a Social Security number issued for your baby?

Mother's Information

* Is your mailing address the same as your residence address?
* Mother's highest level of schooling completed at time of delivery
* Is your household / residence inside the incorporated limits of your city or town?
* Is mother Spanish / Hispanic / Latina?
* Race of mother
Did you receive WIC benefits during pregnancy?
Did you smoke cigarettes before and/or during this pregnancy?