Private HypnoBirthing (5 sessions) * True False Group HypnoBirthing (5 sessions) * True False HypnoBirthing refresher class * True False HypnoBirthing refresher -- # of sessions * Private Birth Works (5 sessions) * True False Group BirthWorks (5 sessions) * True False Preferred day of classes (list 1st thru 3rd choice) M-W-Th-F-Sat * Start time preference (list 1st thru 3rd choice) M-T-W-Th-F-Sat 8am to Noon or M-W-Th 5pm to 7pm * I prefer private sessions in my home at an addl fee * True False Mother's Name * Partner's Name * Email address * Address * Home phone number * Cell or work number * Due date * Mother's occupation * Partner's occupation * Birth careprovider Birth place Doula's name (if relevant) * Is this your first pregnancy? * Yes No Names and ages of other children (if any) * Other childbirth classes attended * Brief description of previous birth experiences (if any) * General health of this pregnancy * Please share insights about yourself that you feel I should know and which will remain confidential. * I understand that a scheduled session may have to be postponed due to Sunday's attendance at a birth. * Yes No Form of payment (Paypal, check, money order) * |Welcome| |About| |Birth Doula Services| |Breastfeeding Support| |Postpartum Doula Services| |Childbirth Preparation Classes| |Childbirth Class Registration Form| |Birth Doula Workshop| |Advanced Doula Training Workshop| |Workshop Registration Form| |Testimonials| |Class and Workshop Schedule| |Internet Links| |Video Clips and Print Materials| |Contact Me|