Customer Details:
First Participant Name
*
First Name
Last Name
Second Participant Name
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
Which course dates are you booked into?
*
Please tell me a bit about yourselves- your professions, ages, backgrounds or any other important info I should know.
What number baby is this for you?
What are you hoping to gain from the Positive Birth Program?
Do you have any concerns or worries when it comes to birth?
What are you most interested in finding out more about or participating in during class?
Objective information and facts
Relaxation, meditation or hypnotherapy approaches
Physical strategies eg. Movement and postioning
Massage Techniques
Other natural approaches to birth
Building confidence
Reframing birth on a psychological level
Meeting and engaging with other couples
Getting answers to my questions
Birth videos
Learning how to give or receive support to/from my partner
Resources and downloads
Other
How did you hear about us?
*
Please Select
Facebook
Google
Instagram
Print Media
Word of Mouth
Other (Please specify...)
Other
Is there anything else you think I should know before we begin the course?
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