Best Birth Forward: childbirth education series

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REGISTRATION FORM:
Self-paced PRIVATE series | Intro and follow-up sessions included

Email *

Please list your full name and preferred pronouns. *

I recommend a partner/support person attend private sessions with you whenever possible. Ideally, this is the same person who will support you during birth. Please provide their name/relation, if relevant.

Do you live in Cape Breton? If YES, are you interested in learning about and getting information on other local perinatal resources/services I often collaborate with?

Yes, and yes please!

Yes, but no thank you.

No, I am not local.

Clear selection

How would you like to communicate following this form?

E-mail

Social media (if we are connected)

Clear selection

What is your due month? *

Who is your primary pregnancy care provider/doctor/OB?

What month would you like to book your intro session before starting the course? *NOTE: Generally, this is at least 2 months before you are due to give you plenty of time to complete the course/closing session and prepare for your birth! Please allow approximately 6 weeks to complete the self-paced portion of the course. You may take more or less time, keeping your due date in mind.* *

What is your usual availability/preference (including partner, if applicable) for our sessions? Select all that apply. *Specific dates will be decided through direct communication.

Weekday mornings

Weekday afternoons

Weekday evenings

Weekends

What birth number is this for you?

First birth

Second or higher birth

Rather not disclose

Clear selection

Is there anything you would like to share about your history/pregnancy that might help me better meet your family’s needs and expectations?

Are there any pregnancy/birth/postpartum topics of particular interest for you?

Are there any special needs/accommodations (academic or other) I should know about prior to the course to better support you?

How did you hear about this course and/or Belle Vie Birth & Baby? This helps me to understand how I'm best reaching clients.

Recommended by a friend

Saw a print poster

Saw a post on Facebook

Saw a post on Instagram

Found via web search

Returning customer/client

Mommy Connections 'Mom to Be' program

Other:

If you were referred by a friend, please provide their full name so I can thank them!

How will you be paying for the course? The $200 fee is required to confirm/hold your spot, unless otherwise requested. Thank you!

E-transfer: belleviebirthandbaby@gmail.com
Make password: bestbirthforward

*Registration confirmation will be sent via email upon receipt of both this form and your payment.* *

Pay now to confirm registration

Payment is partially/fully covered by a promo/gift certificate/other (I will reach out)

Would like to discuss flexible payment options (I will reach out)

NOTE ON INSURANCE

While we cannot direct bill, some clients have had success with insurance companies allowing them to claim and get reimbursed for privately run childbirth education under their "other" category/benefits. It is worth looking into your particular insurance and inquiring. An official receipt can be provided with the necessary information if needed.

THANK YOU FOR REGISTERING! Do you have any questions you would like answered before/when we reach out to confirm your registration or discuss your payment options?

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