Contact Form - Schedule your Complementary Consultation with Rebecca

Your Download is available for direct download here if you want to fill it out hardcopy and email it to me. Alternately, I have provided an electronic form with the same questions below. It doesn't matter which one you use, what does matter is that you make the commitment to yourself and your baby to use one!

Download Your PDF or Fill Out the Online Form Below

Your PDF contains valuable pregnancy tips and insightful questions to ensure you get the most out of your consultation.

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Were You Referred by a Friend or Colleague?*
- Yes
- No
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Who Referred You?
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Your Details
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Name*

FirstLast
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Contact Information

How do you prefer to be contacted
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Contact Preferences*
- Email
- Phone
- Skype / Google Chat, etc.
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Email*

Enter EmailConfirm Email
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Phone
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Skype ID or other chat equivalent
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About Your Pregnancy
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When are you Due?
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One year from now, looking back on your pregnancy and birth, what needs to happen for you to consider it a success?
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What do you feel you are doing well with in terms of your diet? What do you think you need to change to help your body prepare for a natural birth?
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What type of exercise are you participating in? Do you feel like you are staying active enough?
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Who would you like to help coach you through labor and delivery? Have you openly discussed your desires for a natural birth with these people and educated yourself and your coaches about their role in supporting you?
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Have you discussed your goals for labor and delivery with your medical provider? If so, are they supportive?
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Describe your ideal labor and delivery. Who do you want to be present, and who might you have a difficult time -not- inviting to be present?

Lets say your mother wants to be present at the birth, but you know she has some conflict with your partner... who will be your primary coach. Challenges like this can be more stressful than you might think. Having a plan ahead of time is important... what is yours?

Consultation Form

Contact Form - Schedule your Complementary Consultation with Rebecca

Your Details

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About Your Pregnancy

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