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STEP 1
In
formation & Registrat
ion Fo
rm for Doula Care & All Classes
(proceed to Step 2 only following confirmation of availability of class or services)
Birth Matters | Doula Care & Prenatal Classes Registration Form
First Name
Last Name
Pronouns
Preferred Name
Birthday
Address
Phone
Email
Occupation
Partner's Name - if applicable
Partner's Phone Number
Partner's Email Address
Partner's Occupation
Is this your first child?
*
Yes
No
Other
Are you planning a home or hospital birth?
*
Home
Hospital
Undecided
Expected Due Date
Careprovider/Clinic (Dr/Midwife) Name
Are you interested in Doula Care?
*
Yes
No Thank You
Looking For More Information
Practitioner Options
Kayla Wolfe CD-L - Birth Doula
Vanessa Mack CD-L/CD-P Birth Doula/Postpartum Doula
Jodi Anderson - Ltd to repeat families
Match Me with an Available Doula
Match me with a Postpartum Doula
Kelsey Young CD-L Postpartum
Caity Barret PT - Infant Massage & Pelvic Floor PT
Shayla Stanley IBCLC -Lactation Consulting Services
I am interested in your Mentored Labor Doulas
Match me with a Mentored Doula
Kelsey Young CD-L
If you have had previous experiences, is there anything else you'd like to share about previous pregnancies/births?
Choose your Class (check any that apply)
4 Week Prenatal Session
2 Intensive Sessions
Prenatal in a Day
Newborn 101
Breastfeeding 101
Private Birth Prep & Planning Session
All options
Infant Massage - Caity Barret PT
Pelvic Floor - Caity Barrett PT
None ~ thank you!
What are the dates of session(s) you are interested in?
Payment Method Preferences:
I would like to pay by Credit Card online
I would like to pay by e-transfer
I plan to pay by Cash in Office
Please send me an invoice for Credit Card Payment
Additional Comments / Preferences:
How did you hear about us? Did someone refer you? We love to hear how you found us.
We want to provide all of our clients with sensitive, trauma informed care. We endeavour to create safe, comfortable spaces for everyone. If you and/or your partner have a history of trauma, abuse, or mental health concerns we welcome you to share details if you feel the information will help us to serve you better.
Thank You!
Submit
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