In order to best support you in your sacred body milk journey please tell us a few things about your baby and yourself.
Please note that after completing this form you will receive a confirmation notice with the zoom link.
The purpose of this form also serves to collect important group data.
Consent for Services: By completing this registration form you are agreeing that you understand that this support group is meant to provide you with information and education. By completing this registration form you agree that participation in this group does not create a clinical relationship between the support group leader and you. By completing this registration form you agree to understand that you are responsible to consult with your primary care provider and/or your baby’s primary care provider before taking action on anything that happens in the support group setting. By completing this registration form you agree to recognize that if you have an established relationship with the support group leader it is up to you what you wish to share in the group setting about your prior clinical relationship. If you do reveal a clinical relationship, you agree that you understand that the support group leader will not make reference to your private clinical conversations in the group setting and will not provide you with specific or personal clinical recommendations or plan of care. By completing this registration form you give permission to the support group leader to take screenshots of the support group at the end of the group setting. These photographs may be used for promotional purposes on Chichihualtia’s website and social media channels.
