Tiny Toes Registration
Mother's Full Name:   
Father's Full Name:   
Daytime Phone Number:   
Email Address:   
Physician’s Name:   
Due Date: 
Last 4 Digits of Mom's SS Number:
(Not required)
Your registration information will be used to keep you updated on Tiny Toes. It will not be sold or provided to any outside entity. Your acceptance of the merchant discount perks, however, may identify you to local participating merchants as a Tiny Toes member and patient of this hospital. Therefore, we need your consent to provide you with that benefit. Your information would then be subject to the privacy practices of those vendors with whom you transact business. Please indicate your preference:
Please provide me with merchant discount perks. I understand that by accepting any discount, the participating merchant will know I am a Tiny Toes member and that I was a patient at Wesley Medical Center
Please do not provide me with any merchant discount perks.
Merchant participation in Tiny Toes is subject to change. Additional merchants may join or opt out of the program at any time.

By submitting your information through the button below, you are providing your consent to be enrolled in the Free Tiny Toes Program.
For more information on Tiny Toes contact the Marketing Department of this hospital.