Mitera Birth Co.
In Person Workshop Booking Form
Select Workshop & Date
*
Please Select
Antenatal Workshop - 15/01/2026, 6-8pm @ Infinite Wellbeing, Heanor
Birth Workshop - 22/01/2025, 6-8pm @ Infinite Wellbeing, Heanor
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
What is your EDD? (estimated due date)
*
Is this your first baby?
*
Yes
No
Prefer not to say
Will a birth partner be attending with you? If so, please add their name.
*
Do you have any specific needs, health considerations, or accessibility requirements I should be aware of to support you best?
Do you currently have any worries or fears about pregnancy or birth?
How did you hear about Mitèra Birth Co.?
*
Preferred payment method
*
Paypal
Bank Transfer
Consent
*
I understand that all information shared is confidential and used only for class and communication purposes.
Is there anything else you’d like me to know before your session?
Submit
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