Childbirth Class Registration

4 week childbirth class
Blended Lamaze & Hypnobirthing techniques
Come learn everything pregnancy, birth and postpartum!

Full Name

Partners Name (if applicable)

Phone Number

Estimated Due Date

1st, 2nd, 3rd Pregnancy?

Any Medical Condition/Concern

Name/Title of Provider

Desired Birth Location

What are you hoping to get out of this childbirth class?

Do you agree to pay the amount of $250 (or agreed upon amount) for this childbirth course? Payments can be made via Venmo @Patience-Dominick or cash upon arrival. *Payment plans are available

I Agree Need Payment Plan

Childbirth Class Registration

Contact Me And Get A Free Consultation.

Transition Confidently Into Parenthood With Me By Your Side.

My Services

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