I want to gift someone with a doula service:
Please take 5 minutes to fill out this form so that I can find the best way to assist you and for us to meet up in person or virtually via Zoom or Skype. During the COVID-19 pandemic, all prenatal visits are conducted virtually.
Email address *
Mother's Name & Surname *
Your answer
Mother's Mobile Number for WhatsApp communication *
Your answer
Father/Partner's Name & Surname *
Your answer
What country & city is the mother living in? (i.e. where will she be birthing her baby?) *
Your answer
Who are her primary caregivers? (Gynae/Obstetrician name and/or Independent midwives?) *
Your answer
Where does she hope to give birth? Home/Hospital? Which hospital? *
Your answer
Please tick the boxes below to indicate *
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How did you hear about Relax Into Birth / Charlene Yared West? *
Your answer
What other antenatal classes has she done? And with whom? *
Your answer
Please input your enquiry here. *
Your answer
A copy of your responses will be emailed to the address you provided.
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