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Class Intake Form
We are so very much looking forward to joining you on your journey to parenthood.
Please take a few minutes to read the Terms of Service and fill out the form below:
Click here to Read the terms of service
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Indicates required field
Name
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First
Last
Email
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Phone Number
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Your Pronouns
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Birth Partner Name (if you have one)
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First
Last
Partner's Email
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Partner's Phone Number
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Partner's Pronouns
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What town/city do you live?
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What is your estimated due/guess date?
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Who is your medical care provider? Please include their name/group name. If your current care provider isn't your first choice, please state who you would prefer.
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Your chosen birth location (Hospital, Home, Undecided)
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If birthing in hospital, please include the name of the hospital. If you are undecided, please let us know.
What are your primary concerns for this pregnancy and birth?
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Do you have any additional support people?
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Do you have a doula, chiropractor, naturopath, counsellor, spiritual advisor etc)
Before we start working together, is there anything else you would like to share?
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Where did you hear about us?
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Please share their name so we can personally thank them!
Food Allergies (In person classes only)
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I have read and agree to the Terms of Service.
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Yes I agree
No I do not agree
Click button above to read the Terms of Service
I agree to receiving marketing and promotional materials
Submit
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