Queen City Cocoa B.E.A.N.S. Virtual Cafe Registration
One time registration is required to join the cafe. There is no cost or obligation to participate.
A link to the cafe will be given at submission of this form.

Sign in to Google to save your progress. Learn more
Email *
Email
Thank you for helping us keep this space safe and protected for our participants. Often we share sensitive, private and personal information in our cafes. This is an inclusive space. By agreeing and participating in this cafe, you commit to honor confidentiality within and out of this space. Our cafe goals are to facilitate parent to parent emotional support and the sharing of guidance for general and basic questions. The information shared in this space does not replace the clinical care of your physician, your baby’s physician, your IBCLC, your private therapist, or other healthcare providers. The Medical Code of Ethics does not allow for the offering of specific clinical care until there is a professional relationship established. No information provided in this space should be construed as clinical recommendations for your specific case. Due to the nature of this cafe, Harmony Nutrition & Lactation and the practitioners supporting you cannot guarantee HIPPAA privacy. Please check that you have read and understand the statement above. *
First Name *
Last Name *
Phone Number (for texted link) *
Infant age (prenatal or postnatal) *
Please use the link below to sign into the cafe
Cocoa B.E.A.N.S. Virtual Cafe


Please join my meeting from your computer, tablet or smartphone.
https://meet.goto.com/RachelMDean/cocoabeansvirtualcafe

You can also dial in using your phone.
Access Code: 629-999-205
United States: +1 (224) 501-3412


Get the app now and be ready when your first meeting starts:
https://meet.goto.com/install
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy