Application For 1:1 Birth Preparation and Guide

Application For 1:1 Birth Preparation and Guide

Welcome! Step 1: Apply and I'll reach out for step 2!
Name*

First NameLast Name
Email*
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Phone Number*
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Address (To check proximity to me)*

Street Address

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Due Date*

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I have been an RN since 2013, I certified as a doula in 2015 and decided to enter the hospital birth system in 2017 to learn birth in America from all angles. There, while learning and certifying in the intricate understanding of physiologic birth I personally honed my skills in energy work, massage and fascia manipulation, intuition, nervous system guidance and frequency and breath work. What draws you to work with me during your pregnancy and birth?*
While I'm certainly not atheist, I hardly fit into an one particular organized religion. I believe in God and I follow the teachings of Jesus Christ. I apply teachings from different sects and religions that feel intuitively right for me. My teachings can work with those from any religion and I adjust my language accordingly (God/universe, Prayer/Meditation) Please tell me which religion you follow? *
Do you regularly consume any of the following...*

Alcoholnicotine- cigarettes vape of other?THC- Flower, concentrate or vape?PsilocybinMental Health MedicationsOther
Briefly describe your romantic relationship. This helps me understand your dynamic before our first meeting so I can support you properly.*
Would you describe your gender as other than woman?*
Select all that apply to you...*

I have had a severe injury in the past with long term impactI have a reproductive related condition (PCOS, Fibroid, Ovarian cysts, etc.)I conceived via IVFI have had uterine surgeryI have had a miscarriageI have had an abortionI have been a victim of sexual abuseI have experienced traumaI have difficulty achieving orgasmI experience pain during sex
Select a date which would be best for a 30 minute call between 9-3 after reviewing this form. Step 2!*

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