Birthing with Authority
New Eden Birth Wellness Childbirth Education
Thank you for your interest in our Faith-Based and Community-Centered Childbirth Education Course!
We believe birth is sacred, and physiological and we’re honored to walk alongside you in this season. Please complete the form below so we can get to know you, your goals, and how to best serve and support you. This is a 12-hour virtual course. Once this form is submitted, you will receive a payment link to secure your spot.
Name
First Name
Last Name
Birth Partner's Name
First Name
Last Name
Email
example@example.com
Birth Partner's Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Will your birth partner or support person attend with you?
Yes
No
Sometmes
Are you currently expecting?
Yes
No
Planning
Estimated Due Date
-
Month
-
Day
Year
Date
Number of previous births?
Preferred Birth Setting
Home
Birth Center
Hospital
unsure
Type of provider?
Midwife
OBGYN
In search
Are you a client of New Eden Birth and Wellness
Yes
No
Do you have a doula?
Yes
No
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Have you previously taken a CBE course?
Yes
No
How do you learn best?
Visual
Discussion
Journaling and reflection
Homework
Will you be attending live or watching replays mostly?
Live
Watching Replays
Both
Are you comfortable sharing in a group setting?
Yes
No
Do you have a birth plan?
Yes
No
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Why did you decide to enroll?
What are you hoping to gain or feel more confident about by the end?
What are your biggest fears or concerns about birth right now?
What does a successful birth look like to you?
How would you describe your faith/spiritual background?
Christian
Non religious
Other
Would you like prayer of spiritual encouragement as part of this course.
Yes
No
Are there any spiritual or emotional wounds around pregnancy loss or birth that you want held gently in this space?
If you could speak one prayer over your pregnancy and birth, what would it be?I
Do you agree to honor confidentiality and hol others' stories with care?
Yes
No
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To better accommodate family schedules, we are offering two attendance options: Option 1: Weekday Cohort Tuesdays & Thursdays 11:00 AM – 1:00 PM• July 7• July 9• July 14• July 16• July 21 Backup Date: July 23 Option 2: Saturday Cohort• July 11 | 10:00 AM – 1:00 PM• July 25 | 10:00 AM – 1:00 PM• August 1 | 10:00 AM – 2:00 PM
Option 1
Option 2
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