DHP: Home Visit Registration Form FY 25-26

Step 2: Enter information as seen on your Driscoll Health Plan Card

To make sure you are registered for one of our classes, please review the information below as seen on your Member Identification Card.
Name

First NameLast Name
Line of Business
Date of Birth

MonthDayYear
Members who participate in a DHP Home Visit within 60 days after delivery earn a $20 gift card for attending one DHP educational Home Visit class. *Restrictions and limitations may apply.
Mailing Address
Street Address
City
City
State
State
Zip Code
Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email

Confirmation Emailexample@example.com
May we text or email you class information?
Be sure to check your emails for class schedule reminder.

Step 3: Enter information to continue with registration
Date of Delivery

MonthDayYear
Date
Current

MonthDayYear
Date
C Date

MonthDayYear
Date
Days since delivery
Thank you for your time. At this time, you are not eligible for this class. Please call Member Services to get more information about other educational classes.

Step 3: Enter information to continue with registration