your full name *

First Name

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partner's full name *

type N/A if not applicable

First Name

Last Name

residential address *

Address 1

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City

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estimated due date *

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DD

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dietary requirements *

nut allergy

GF

DF

vegan

vegetarian

none

other

pregnancy/birth history

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miscarriage or stillbirth

breastfeeding issues

traumatic birth

caesarean birth

instrumental birth

preterm birth

vaginal birth

physical recovery issues

depression/anxiety

postpartum haemorrhage

what would you like me to cover in our sessions *

select all if you like!

physiology of labour

labour coping techniques and tools

partner involvement

breastfeeding

postpartum planning

birth planning/mapping

birth team & birth space planning

care provider options

acupressure/massage/rebozo

labour positions

previous birth debrief

free hire requirements *

select all required

TENS machine

birth pool

birth sling

postpartum support band

none