Booking Enquiry for Postnatal Services
Thank you for your interest in my postnatal services! This enquiry form will help me to understand what sort of support you require so that I can put together a package proposal for you.

***IF YOU ARE BOOKING MY PLACENTA ENCAPSULATION SERVICE PLEASE CLICK HERE*** https://goo.gl/forms/8TZg5iI8OQHItWCw2

If you have any questions please do not hesitate to contact me. :)

Christa Buckland
BHlthSc (Health Promotion)
Doula, Childbirth Educator, Hypnobirthing
0422 229 312
christa@naturalbirthconnection.com

Email address *
Name *
Your answer
Phone number *
Your answer
Address *
Your answer
Estimated Due Date (EDD) *
MM
/
DD
/
YYYY
Partner's name (if applicable)
Your answer
Is this your 1st, 2rd, 3rd, etc. baby? *
Are you planning a vaginal or caesarean birth? *
Package Proposal
Please provide some information so that I can build a package for you that will meet your needs.

Note: All visits are 3 hours each.

How many visits are you interested in? *
Required
How many weeks would you like support for? *
Required
What are your primary reasons for wanting a postnatal doula? *
Your answer
What type of support are you interested in? (select as many as you like) *
Required
Is there any important information you wish me to be aware of?
Your answer
Payment Terms
No payment is required when you submit this form as this is a booking enquiry only, however please note the following payment terms should you choose to book my services.

1. Once you decide on a package, I will send you an invoice.
2. A non-refundable retainer is required to hold your position. The retainer is $300 and is not refundable under any circumstances.
3. The remainder of your fee is due no later than 36 weeks. If the remainder of your fee is not paid by this time, you forfeit your booking.
4. If you are booking my services after 36 weeks, the full fee is due within 7 days.
5. After 36 weeks, no portion of the fee is refundable unless exceptional circumstances arise.
6. Refunds are given solely at my discretion and are not given for change of mind.

Please check the box below to acknowledge that you have read and understand the above terms. *
Required
Payment can be made via Direct Deposit (preferred) or PayPal.
No payment is required at this time. Thie following details are provided for future reference.

Direct Deposit Details:
Bank: ANZ
BSB: 012-556
A/C: 587550123
Name: Christa Buckland

Please let me know if you wish to pay by credit card and I will create a PayPal link for your payment. Alternatively, you can pay directly to my PayPal account: christa.buckland@live.com

A copy of your responses will be emailed to the address you provided.
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