GMD CIC Initial enquiry form

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Thank you for contacting Greater Manchester Doulas CIC.

This form is to determine the kind of support you would like, and asks you for some basic information to help us get a better picture of how we can support you. Please fill out as much as you would like, and go into as much detail as you are comfortable with. All answers will be of course be kept confidential.

First Name

Last Name

Email address

How did you hear about GMD?

Word of mouth

Facebook

Instagram

Google/other search engine

Other:

What area do you live in?

Do you live in (or very near) Miles Platting and/or a Jigsaw Home? (We have specific funding for women in this area/housing)

I live in Miles Platting

I live in a Jigsaw Home

A Jigsaw Home in Miles Platting

Clear selection

Are you currently pregnant?

Yes

Clear selection

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