BBG New Client Inquiry Form - Prenatal Companion Program (Hospital Birth)
Thank you for taking time to complete this inquiry form. The information you provide on this form will assist us in understanding your goals and desires and expectations for our Supportive Birth Network program. Please note that this program is not intended to replace your current maternity care provider, but to lend a personalized, midwifery  perspective to support you throughout pregnancy, birth and beyond to achieve the best birth outcome possible.  This program investment is $2500.00.
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Email *
Full Name *
What is your age? *
What city to do you reside? *
What number baby is this for you? (1st, 2nd etc..) *
Do you have any medical problems? Any surgeries in the past? Taking medication? *
Why are you interested in BBG's  Supportive Birth Network Program? *
What hospital are you planning to give birth? *
Who is your primary prenatal care provider (What practice or group)? *
Do you live a healthy lifestyle? (healthy eating habits, exercise etc.) *
What are your goals for your childbirth experience? *
 Hiring a doula is strongly recommended for first time mothers. Are you prepared to hire a doula to support you through pregnancy and labor? *
Midwifery care is a partnership. This type of concierge-style maternity care encourages mothers to be active participants in their own care. There is also a higher level of responsibility that is required when planning for a non-medical approach to your maternal health care.  Are you willing to accept this level of accountability , suggestions & modifications necessary throughout your care to achieve the goal of a healthy pregnancy and birth? *
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