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Childbirth Education Registration
We are very much looking forward to out work together. Please make sure your email is correct. Additional reading, handouts, links, and videos for you to look through at your leisure is provided with every class.
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Name
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Email
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Mailing Address
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Phone number
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What is your due date?
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Planned birthplace:
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Your answer
Pregnancy care provider:
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Your partner's name (if applicable):
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How many children do you have?
Your answer
What are your hopes and goals for your birth experience?
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What are your concerns or fears about your birth experience?
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Is there anything else about your experience you want me to know or help with?
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Have you taken any childbirth education classes previously?
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How did you hear about this class?
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Wellness Village NH
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