RSVP 1 — Dr Lauren Downie

Calmbirth Registration

Please take the time to fill out this form prior to attending your booked Calmbirth course.

If you have not yet booked in to a course, please click here to book.

Which course are you attending?

Mother's full name

First Name

Last Name

Partner/Support person's name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Mother's occupation

Partner's occupation

Do you have any specific fears or phobias? (either mother or partner)

Do you or your partner have any medical or psychological conditions?

Do you take any medications on a regular basis? Could you please list them.

What number child is this for you?

What model of care are you having for your pregnancy?

What are your feelings about birth prior to your Calmbirth class? Do you have any specific fears or concerns?

What would you like to get out of your Calmbirth course?

How did you hear about Calmbirth?

Do you give permission for Calmbirth to use any of your photos, testimonials or birth stories for print or online marketing?

Testimonials would only be shared online with express permission from individuals after they have been provided

Yes

Disclaimer: The Calmbirth class program includes psychological and emotional preparation for birth. I understand that the delivery of the course will include guided relaxation as a means to facilitate emotional subconscious healing of fear and anxiety about childbirth.

Yes