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Printable
Registration
Form
Please
print this out and mail or fax to:
Birth Doulas Of Marin
P.O. Box 336 Mill Valley, California 94942 Fax: (415) 388-9533
Name
_________________________Partner's Name _______________________
Address
____________________________City ____________________ Zip _________
E-mail
address________________________________
Phone
____________Cell________________ Work____________ Due Date _______________
Obstetrician
_______________1st Baby ___ 2nd ___ 3rd ___ VBAC ___
We would like to take this opportunity to congratulate you on the upcoming birth
of your child!
This is an exciting time and we are looking forward to helping
you create a positive birth experience.
The information you provide will help us
to better support you both.
How
did you hear about us?
Have you taken childbirth classes?
__no __yes If yes, what type of classes, and where did you take them?
Do you have any allergies or sensitivities?
__no __yes If yes, please tell us what they are and how they affect you.
................................................................................................................................................
Please
mail or fax to the address above along with your Getting to Know You
and
Guidelines and Fees forms.
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