HypnoBirthing® NY
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Full Name
Partner's name (if applicable)
City
Zip Code
Phone Number
Email address
When is your baby expected?
Birthing facility
Midwife/OB's name
Have you taken any childbirth classes?
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Yes
No
Which childbirth class?
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Bradley
General
Hospital classes
HypnoBirthing
Lamaze
Plans for the birth
What Doula Tier are you interested in?
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Less than $1000
Up to $1500
Up to $2000
Experienced doula up to $3000
Special circumstances related to your pregnancy
Are you interested in Postpartum Doula services?
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Yes
No
How did you hear about us?
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