I want more information about Charlene and her offerings...

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Please take 5 minutes to fill out this form so that I can find the best way to assist you and for us to meet up in person (which is preferred) or virtually via Zoom or Skype. Subsequent visits are in person. I am looking forward to connecting with you. *Free doula consultations are offered if you have completed the Relax into Birth programme. If you do not use my doula services there will be a R350 fee for the consult, otherwise there is no charge.

Email *

When is your estimated due date? *

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Mother's Name & Surname *

Mother's Mobile Number for WhatsApp communication *

Father/Partner's Name & Surname *

Father / Primary Partner's Number for Whatsapp communication *

What country & city are you living in? (i.e. where will you be birthing your baby?) *

Who are your primary caregivers? (Gynae/Obstetrician name and/or Independent midwives?) *

Where do you hope to give birth? Home/Hospital? Which hospital? *

Are you planning on hiring a doula? If you have already hired a doula, who have you hired? (For birth back-up purposes, this is helpful.) *

Please tick the boxes below to indicate *

I would like to find out more about Charlene's online Relax Into Birth course.

I would like to find out more about hypnobirthing.

I would like to meet with Charlene for an information gathering session for planning my birth. (This meeting is free if you have completed the Relax Into Birth course / hire me as your doula.)

I would like to meet with Charlene to find out more about her doula offering.

I would like a one-on-one fear release hypnotherapy session with Charlene.

I would like a prenatal or postnatal massage treatment.

I would like to find out more about placenta encapsulation.

I would like to find out more about hiring an epi-no device.

Other:

Required

How did you hear about Relax Into Birth / Charlene Yared West? *

What other antenatal classes have you done? And with whom? *

Is this your first pregnancy?
How many children do you have? *

Please input your enquiry here. *

*Free doula consultations are offered if you have completed the Relax into Birth programme
*If you do not use my doula services there will be a R350 fee for the consult, otherwise there is no charge.
*

A copy of your responses will be emailed to the address you provided.

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