Reboot Refresher Workshop
A Class For the Experienced Couple
Mom's Name
Mom's Occupation
Dad's Name
Dad's Occupation
Address
Mom's Email
Dad's Email
Mom's Phone Number
Dad's Phone Number
Mom's Age
Estimated Due Date
MM
/
DD
/
YYYY
Number of Children
Number of Medicated Births
Number of Unmedicated Births
Number of Cesareans
Number of VBACs
Where are you planning on having your baby?
Who is your care provider?
Are you planning on hiring a doula?
How did you hear about Birth Boot Camp?
How do you feel about taking Childbirth Classes?
How does your partner feel about taking Childbirth Classes?
What kind of birth experience are you desiring to have? (ex: unmedicated, water birth, homebirth, medicated, etc.) Feel free to elaborate.
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