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Retreat Enrolment
Name
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Email Address
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Phone
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Retreat Date
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Your Name
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Your Occupation
Partner's Name
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Partner's Occupation
Street Address
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Apartment, suite, etc
City
State/Province
ZIP / Postal Code
General health
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Any previous or current pregnancy complications?
Any general or pregnancy related concerns?
Medications?
This is your 1st child? (Insert number)
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Due Date
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Who is your Midwife/Doctor?
Where are you planning to give birth to this baby?
What kind of birth are you hoping to achieve?
Dietary Requirements?
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