I want to gift someone with a doula service:

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Please take 5 minutes to fill out this form so that I can find the best way to assist you and for us to meet up in person or virtually via Zoom or Skype. During the COVID-19 pandemic, all prenatal visits are conducted virtually.

Email *

Mother's Name & Surname *

Mother's Mobile Number for WhatsApp communication *

Father/Partner's Name & Surname *

What country & city is the mother living in? (i.e. where will she be birthing her baby?) *

Who are her primary caregivers? (Gynae/Obstetrician name and/or Independent midwives?) *

Where does she hope to give birth? Home/Hospital? Which hospital? *

Please tick the boxes below to indicate *

I would like to find out more about Charlene's online Relax Into Birth course.

I would like to find out more about hypnobirthing.

I would like to meet with Charlene for an information gathering session for planning my birth. (This meeting is free if you have completed the Relax Into Birth course / hire me as your doula.)

I would like to meet with Charlene to find out more about her doula offering.

I would like a one-on-one fear release hypnotherapy session with Charlene.

I would like a prenatal or postnatal massage treatment.

I would like to find out more about placenta encapsulation.

I would like to find out more about hiring an epi-no device.

Other:

Required

How did you hear about Relax Into Birth / Charlene Yared West? *

What other antenatal classes has she done? And with whom? *

Please input your enquiry here. *

A copy of your responses will be emailed to the address you provided.

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