Doula Consultation Request
Complete this form to request a complimentary consultation with Julia!
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First and Last Name
*
Your answer
Partner's First and Last Name
*
Your answer
Estimated Due Date
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MM
/
DD
/
YYYY
Type of Service(s) You are Interested in
*
Birth Support
Postpartum Support
Childbirth Education
CPR Training
First Aid Training
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Birth Location
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Your answer
City/town of Residence
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Preferred Method of Contact
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Text
Phone Call
Email
Additional Notes
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