Space 2 Flourish Prenatal Class Registration
Contact info:
Carmen Ohori
(250) 640-0678 mobile
carmen@space2flourish.ca
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Personal Information
Helping us learn about you will make for a rich and productive learning environment as you prepare for your birthing journey.
Birthing Person's Full Name *
Email *
Phone Number *
Partner/support person
Partner/support person Phone Number
Due date
MM
/
DD
/
YYYY
How many pregnancies have you had? *
Have you experienced any pregnancy loss? *
Can you please briefly share any current or past pregnancy complications (including loss)?
Any allergies? *
Can you briefly share any specific topics you are hoping to learn about?
Where do you plan on birthing your child? *
On a scale of 1 to 10 how much do you know about pregnancy? *
On a scale of 1 to 10 how much do you know about labour and birth? *
On a scale of 1 to 10 how much do you know about breastfeeding/chestfeeding? *
On a scale of 1 to 10 how much do you know about newborn care? *
Do you have any concerns about the prenatal class or personal matters you think Carmen should be aware of? *
Thank you!
You are welcome to contact Carmen if you have any questions or concerns about this program. I look forward to meeting you.                                                           
carmen@space2flourish.ca
(250) 640-0678 mobile   
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