Appointment Request Form

Full Name*

First NameLast Name

Phone Number*

Email*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

What days work best for you?*

What time works best for you?*

MorningAfternoonEvening

Any specific date/time?

DayMonthYearHourMinutesAM/PM Option

What would you like to achieve from our visit?*

Eg; I'm not sure how to fit my Ergo carrier

Which service would you like to purchase?*

30 minute in home babywearing consultation - $5045 minute in home babywearing consultation - $6590 minute in home babywearing consultation - $9030 minute online babywearing consultation - $302 hour in home infant first aid session - $55 per person (min. 4 people)Tupler Technique Program - $550

Any additional information that we should be aware of?

How did you hear about us?

GoogleReferralHealth ProfessionalOther

TERMS AND CONDITIONS

Cancellations and Refunds: Once payment has been received no refunds or credits will be issued for cancellations. If anyone in your household is unwell, please let us know and our booking will be rescheduled.

Payment: Once a date and time is confirmed, you will be issued an invoice. Payment can be made in full via bank transfer or Paypal. Your session is not confirmed until full payment is received.

Babywearing Consultations: If you have purchased our 'Rock-A-Bye Baby' 30 minute consultation, we will discuss tips and tricks to perfect the fit of your carrier. Our 45 minute 'Wrapped In You' consultation, we will focus on your own carrier and I will bring 1-2 carriers for you to try. At our 90 minute 'Wrapped With Love' consultation we will try on a variety of up to 5 carriers to help you decide which one suits you best. All carriers will be freshly washed for your consultation. Our online consultation we will do a virtual fitting and discuss tips and tricks for your current carrier.

PHOTOGRAPHY PERMISSION

Photographs may be taken during the session and used for publicity and promotional purposes. If you do not wish to be photographed, or prefer for your face/childs face to be obscured, please let me know.

Would you like to be notified about promotions? Please note that Pregnancy to Parenthood will never pass on your information to any third parties*

YesNo

Signature (by signing and submitting this form you agree to the above terms and conditions)*

Date*

Date