Booking Form
Please complete the form below to book my services.


If you have any questions please do not hesitate to contact me. :)

Christa Buckland
BHlthSc (Health Promotion)
Doula, Childbirth Educator, Hypnobirthing
0422 229 312

Email address *
Which service are you booking? *
All services INCLUDE Nurtured Mamas Program. This option is for clients who are booking into Nurtured Mamas Program as a stand-alone service.
Name *
Your answer
Phone number *
Your answer
Address *
Your answer
Estimated Due Date (EDD) *
Birth Companion Name *
Your answer
Relationship to you (e.g. spouse, partner etc.) *
Your answer
Intended place of birth (e.g. name of hospital, birth centre or home) *
Your answer
Care Provider *
Care Provider Name (if applicable)
Your answer
Is this your 1st, 2rd, 3rd, etc. baby? *
Is this birth a VBAC (Vaginal Birth After Caesarean)? *
Is there any important information you wish me to be aware of?
Your answer
Payment can be made via Direct Deposit (preferred) or PayPal.
Direct Deposit Details:
Bank: ANZ
BSB: 012-556
A/C: 587550123
Name: Christa Buckland

If you wish to pay by credit card, please click here:

Payment Terms
Nurtured Mamas Program - $300
Hypnobirthing (group class) -$550
Doula service - $1450
Package discount (doula and hypnobirthing) - $1750

Payment & Refunds:
Nurtured Mamas - payment in full is required and is non-refundable.

For hypnobirthing: $150 is required upfront and is non-refundable. Balance must be paid no later than 7 days prior to the course start date. If you cancel within 7 days of commencement of class, no portion of the fee is refundable.

For doula service: 50% of the total doula fee is required upfront and is non-refundable. Balance remaining must be paid by 32 weeks (according to the EDD you provide in this form). After 32 weeks, no portion of the fee is refundable. This compensates me for time spent with you as well as the loss of opportunity to work with other clients (see Letter of Agreement for Doula Services for full details).

Refunds are not given for change of mind.

Please check the box below to acknowledge that you have read and understand the above terms. *
A copy of your responses will be emailed to the address you provided.
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