Enrolment Form for Positive Caesarean Course

The Positive Caesarean Course

The Course fee includes

4 hours of private session (in person or Skype)
Hypnobirthing Australia™ folio of additional reading and resources,
plus ongoing support of your pregnancy and birth
A complimentary gift bag, personally prepared for you to indulge your pregnancy and birth

<Please send the enrolment form below with a $150 non-refundable tuition deposit to secure your booking.
Final payment is due 7 days prior to course start date.>

Fee : $400 Per Couple

Payment can be made Paypal

Paypal Details:
Bitna@birthingbreeze.com.au

Enrolment Form

* Indicates required field

Hypnobithing Mother's Name *

First

Last

When is your birth scheduled? *

Birthing Companion (Name of spouse, partner etc.) *

First

Last

Relationship *

Birthing Assistant (if applicable) *

Relationship (doula, friend, etc.) *

Email *

Preferred Phone Number *

Alternate Phone Number *

Mailing Address *

Suburb, State, Postcode *

Care Provider Name & Title (e.g. Obstetrician or Midwife) *

Place of birth (name of hospital) *

How many weeks pregnant will you be when you begin classes? *

Is this your 1st, 2nd, 3rd etc baby? *

Is this your 1st, 2nd, 3rd etc Caesarean Birth? *

Is there any important information/medical conditions/psychological or psychiatric treatment you need me to be aware of before classes commence? *

I wish to enrol for the Hypnobirthing Course beginning (date) *

Location *

How did you hear about us? *

Submit

The Positive Caesarean Course

Enrolment Form

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