Nurturing Circles Inquiry Form

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Thanks for taking the time to fill out our Inquiry Form.

We look forward to learning more about you.

Once you have submitted this form you will be contacted within 24-48 hours to schedule a free 15 minute phone/video chat.

I'd love to chat with you about your pregnancy/lactation/birth/postpartum needs and how I can best support you. I currently serve a very limited amount of births (1-2) per month. My personal calendar is closed for labor & birth support during 2 months each year for quality family time. Please be advised that during these months I work closely with aspiring doula mentees to provide support. If you have not reviewed my services already, please feel free to do so here.

Let's see if we're a good fit for each other and how I might be able to serve your family with a customized experience.

~ @BirthworkMama Christian (a.k.a. Ann-Marie)

Email *

Record my email address with my response

First Name *

Last Name *

Phone number *

First & Last Name of Partner/Spouse/Support Person and their Relationship to You?

If none, write "My Baby"

When is the most convenient time to reach you? *

How many weeks pregnant are you? Or, when did you deliver? *

What is your due date? Or Baby's date of birth? *

What type of labor/birth are you planning for?

Or did you have?

Home Birth

Birth Center

VBAC

Unmedicated, Vaginal, Hospital

Medicated, Vaginal, Hospital

Cesarean (a.k.a. Belly Birth)

Required

Where do you plan on giving birth? Or where did you give birth?

Please provide name of Birth Center or Hospital and City, State.

If planning a Home Birth, please provide zip code

What Learning Circles (Classes) are you interested in? *

Newborn Care: Be Prepared for Bringing Baby Home

Childbirth Series - Preparing for Your Baby's Birth-Day or Night with Confidence & Coping Tools

Coping with PAIN in Labor - Hands-On Practice for Mind & Body (Refresher Course)

Breastfeeding Your Newborn - What to Expect the First Few Weeks (Pre-requisite for Express Yourself)

Express Yourself: Balancing Feeding; Pumping; and Being Away from Baby (must take Breastfeeding Your Newborn first)

Mom & Baby Yoga

Prenatal Yoga

Other:

Required

What are the biggest challenges you are facing? *

What are your fears, if any, about labor, birth & postpartum (4th Trimester)? *

Why would you like to work/learn with me? *

You understand I am a highly skilled doula & board certified lactation consultant (IBCLC), AND I am NOT providing medical advice AND that my coaching, education & support should in NO WAY replace sound treatment from a licensed health care provider. The services you receive from me are not licensed or regulated by a governmental body. * *

We love word of mouth. Shout out who referred you to us! Or please list how you found our services.
*

Send me a copy of my responses.

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