The Secret Art of Labor & Delivery
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Intake Form
This form will help us get to know you and have a sense of what you would love to get out of this course. <3
What is your name? *
What is your email address?
When is your baby due?
MM
/
DD
/
YYYY
Will this be your first labor & delivery?
Clear selection
How important to you are each of these motivations? *
Not at all important
A little important
Neutral
Important
Super important
Avoiding injury & emergency medical procedures during L&D
A more comfortable, easy birthing experience
Healing generational & personal trauma during L&D
More control/participation during L&D
Feeling confident no matter what Covid-19 brings!
Other (please describe below)
What would you love to get out of this course?
Would you prefer group session or one on one?
Clear selection
When (mm/dd/yyyy), where (city/state/country), and what time (am/pm) were you born?
We will email you shortly with follow up information on how you can start preparing before the course begins and other welcome information. In the meantime, do you have any other questions we can answer?
Submit
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