Your name
*
First Name
Last Name
Your preferred pronouns:
Do you identify as Aboriginal or Torres Strait Islander?
Do you identify as LGBTIQ+?
Your home address
If you have booked an online session, please just enter your postcode below.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Your email
*
Your phone number
*
(###)
###
####
Preferred method of contact:
Other:
Partner/Support persons name (if applicable)
First Name
Last Name
Partner/ support persons preferred pronouns:
Do you identify as Aboriginal or Torres Strait Islander?
Do you identify as LGBTIQ+?
Partner/Support persons phone number
(###)
###
####
Partner/Support persons email
Preferred method of contact:
Other:
Your estimated due date
MM
DD
YYYY
Birthing location
If you have had previous pregnancies, what were the outcomes? (vaginal birth, cesarean birth, VBAC, multiples, loss, etc.) Please include as many or as little details as you’d like.
Please describe your physical and emotional prenatal and pregnancy experience so far:
Have you experienced any complications with this pregnancy so far? Do you have any restrictions or medications from your care provider regarding this pregnancy?
In what ways are you already preparing for childbirth during this pregnancy?
i.e. other classes, books, websites, therapy, movement etc.
Are there specific topics you would really like to learn more about?
What do you think will be your greatest challenge for this pregnancy, birth and/or postpartum experience? If applicable, what about your partner/support person(s)?
What do you think will be your greatest strength for your pregnancy, birth and/or postpartum experience? If applicable, what about your partner/support person(s)?
In what ways are you already preparing for postpartum? If you're feeling a little lost with this, would you like some guidance?
i.e. books, classes, meal train, mental health support, lactation consultant etc.
How do you plan on feeding your baby?
If you plan on another method of feeding your baby, please explain below:
While we cover alot, it's great if we can focus the session on a few key topics and go into them more deeply.
From the below list, select your top two or three 'topics' that you would like to explore together:
Please share anything else you would like me to know about you and/or any topics you'd like to cover:
