Birth Pool Inquiry Form

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Birth Pool Inquiry Form

Congratulations! Please fill out and we will get back to you shortly with Pool Availability!

* Indicates required question

Email *

Record my email address with my response

NAME: (first & last) *

Your answer

Phone Number & Email: *

Your answer

ESTIMATED DUE DATE: *

MM

/

DD

/

YYYY

Registered Midwife *

Your answer

Which Pool are you Inquiring About? *

Birth Pool in a box ( inflatable, blue)

AQUA DOULA Pool (hard sided pool, green)

Either

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