Thank you for reaching out ! Please complete this form for a free consultation . Once submitted, I will reach out with 24-48 hours with times and dates.
Love, Your Doula
Full Name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
E-mail
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example@example.com
If you are expecting, when is your Estimated due date?
Services
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Birth and Labor
Birth Planning
Post Partum
Lactation
CPR/ AED/ First Aid Instruction
Child Passenger Safety
Parent Education
Safe Sleep Course
Belly Binding
Placenta Encapsulation
Other
Pick choose all services you are interested in
If Other: Please describe
When are you wanting to schedule a consultation?
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Within 48 hours
Within the next week
Within the next 2 weeks
Would would you like and day or evening time ( day 9am- 4pm, evening 5-8pm)
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Day
Evening
No Preference
Would you want a weekday or weekend consultation?
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Weekday
Weekend
No Preference
Tell me a little about yourself?
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Example: Family Dynamic, Type of Delivery, Multiple births,
Comments/ Questions/ Concerns?
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