Getting To Know You Form

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Getting To Know You Form

Kindly fill out the form below as best you can!

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* Indicates required question

Mom's Name *

Your answer

Dad's Name *

Your answer

Mom's Email *

Your answer

Dad's Email *

Your answer

Mom's Phone Number *

Your answer

Dad's Phone Number *

Your answer

Mom's Age *

Your answer

Who is your care provider? *

Your answer

Is This Your 1st Baby? *

Yes

No

If not, how many kids? *

Your answer

How were your previous births? *

Your answer

How is this pregnancy going? *

Your answer

What would you like from this class? *

Your answer

Would you like me to add you to my mailing list?

(This way I can continue to provide you with info on pregnancy, birth, postpartum and parenting!)

*

Yes

Not at this time

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