Leanbh Babywearing Consult Request Form 2019
Thank you for choosing Leanbh Babywearing for your babywearing consultation. This questionnaire is designed so that I make the most of our time together. Please provide as much information as possible. I look forward to meeting with you. Best wishes, Abina
Name *
Your answer
Address incl Eircode *
Your answer
Is there anything I need to be aware of about access or parking etc? *
Required
Mobile Phone Number *
Your answer
Email address *
Your answer
Child's name(s) and age(s) or if you are currently pregnant, please specify no of weeks: *
Your answer
Type of consultation required *
Required
What date/time might suit you? (I will confirm by return if this suits or I will suggest another suitable time slot) *
Your answer
Please specify who will be attending the consult *
Required
How do you anticipate using the carrier *
Required
Were there any complications during pregnancy or birth that may affect babywearing? *
Required
Was your baby born prematurely (if so, at how many weeks & birth weight) *
Required
Do you and/or your partner (if applicable) or child have any pre-existing medical conditions or disabilities that may affect babywearing? *
Required
What areas of babywearing are you particularly interested in covering in this consultation (choose as many as you like) *
Required
How would you rate your current level of babywearing proficiency? *
Required
Are there any carriers in particular you would like to try out or get more information about at the consultation? *
Your answer
Sling hire is available after your consultation. The cost to hire one sling for one week is €5 or for 2 weeks it's €8. A deposit of €50 is required for each sling hired. Any late fees, costs of repair or replacement of the sling and/or accessories will be deducted from this deposit. *
Required
Any other information that may be relevant to your babywearing consultation:
Your answer
Do you give consent for Leanbh Babywearing to contact you in relation to occasional special offers, newsletters and updates in the future? *
Required
All information and personal details you have provided in this form will be kept in accordance with the General Data Protection Regulation 2018. The information collected is to enable us to provide you with a one to one babywearing consultation and will not be used for any other purpose. Your information will be stored for 1 year from the date of completion. Full Privacy Statement https://www.leanbhbabywearing.ie/privacy-statement--cookie-policy.html
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