Birth Hypno-Breathwork Intake
You don't have to have it all figured out to fill this out. Just answer honestly and I'll take it from there.
SECTION 1 - About You
Full name
*
First Name
Last Name
Email address
*
example@example.com
How far along are you?
*
Is this your first pregnancy?
*
Please Select
Yes
No
SECTION 2 - What You're Looking For
What kind of support feels right for you?
*
Please Select
Single session — I have a specific fear or anxiety I want to move through
Pregnancy series — up to 3 sessions to shift my mindset and feel ready
Not sure yet — I just know I want support
What's on your mind going into birth right now?
*
SECTION 3 - Quick Health Check
Has your care provider flagged anything in your pregnancy I should be aware of before we work together?
SECTION 4 - Waiver
I understand that these sessions are not a substitute for medical care or mental health treatment. I agree to the terms and liability waiver at ashlynkwilson.com/terms.
*
I agree
By submitting this form you agree to the terms and conditions outlined at ashlynkwilson.com/terms
Submit
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