Booking an on-line Hypnobubs® Birthing Class
There are multiple options when booking this on-line course. So please take time read carefully and select the package you are wanting. You can choose from the following options:
   • Basic Package  ($199)
   • Positive Caesarean ($199)
   • Change of Circumstances ($149)
         o Additional tracks and tools for a Caesarean Birth
   • Value Package
         o Basic Package, plus Change of Circumstances  ($259)
You can combine any of these with some one on one time with me, either face to face or via Zoom or Skype
   • 90-minute upgrade ($150)
   • 3-hr upgrade ($300)

Sign in to Google to save your progress. Learn more
What is your Full Name? (And in brackets the name you would like to go by in class) *
What is your home address? If your mailing address is different, please supply your postal address. *
Phone number *
E-mail *
What is your best email address to contact you on? *
Preferred contact method *
Required
What is your support person's Full Name? (in brackets the name they would like to go by in class). *
What is your support persons relationship to you?
When is your baby expected to arrive? (knowing your baby is not reading this and might not agree to arrive then) *
MM
/
DD
/
YYYY
Where are you planning to Birth your Baby?
Clear selection
Who is your pregnancy care provider?
Clear selection
What birthing class would you like to book in for *
Would you like the upgrade to go over things one on one with Debra after the course? *
Questions and comments
Do you have any specific questions that need answering prior to doing the course.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of empoweredtobirth.com.au.

Does this form look suspicious? Report

Google Forms