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Calmbirth ® Weekend Workshops cost $550.00 per couple (includes GST)

    Name (required)

    Email (required)

    Phone (required)

    Calmbirth session date (required)

    Mother's Name (required)

    Mother's Occupation

    Partner's Name (required)

    Partner's Occupation

    Address

    Postcode

    General health

    Any previous or current pregnancy complications?

    Any general or pregnancy related fears or phobias?

    Medications?

    This is your nth child? ( Insert number )

    Due Date of this baby (required)?

    Where are you planning to give birth to this baby?

    Who is your Midwife/Doctor?

    How did you hear about Calmbirth classes?

    What kind of birth are you hoping to achieve?

    Dietary Requirements?

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