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Prenatal Yoga Inquiry Form
Please take a few minutes to help me get to know you better and how I can best serve you!
Yoga experience is not required for our circle time but I really like to know each persons experience level so I can best accommodate everyone.
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Full Name
Your answer
Contact Info
Your answer
City of residence
Your answer
Your estimated due date
MM
/
DD
/
YYYY
Anything you would like me to know about your baby: sex, name, number of pregnancies, etc.
Your answer
Where will you be birthing?
Hospital
Birth Center
Home
Not sure
Clear selection
Details of your desired birthing location: which hospital or birth center, etc.
Your answer
Do you have a birth support person or team? If so, who will be supporting you during your birth?
Your answer
Do you currently, or in the past, practice yoga? If so, please share a little of what that looks like: home or studio practice, integrated with meditation or just mostly asana, etc.
Your answer
Please list any physical issues or limitations you are experiencing:
Your answer
Please list any mental or emotional challenges you are experiencing:
Your answer
Do you have consent from your care provider to practice prenatal yoga?
Your answer
Do you have any of the following items:
yoga mat
birth/yoga ball
blocks
bolster
yoga blanket
none of the above but I'm interested in purchasing one or more items
none of the above I would prefer to borrow any extra items you have to use
Please list your desired days of the week and times for prenatal yoga circle.
(From time to time I will form groups by desired days and times of the week so this can be helpful in those situations)
Your answer
Please share where you found my prenatal yoga offerings? If referred from a friend please share their name so I can personally thank them.
Your answer
Please feel free to add anything else you would like me to know about you below.
I appreciate your time and thank you for completing my inquiry form.
I will be in touch with you soon!
-Kim, Your Doting Doula
Your answer
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