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Birth Education
Thoughtful Birthing
Your Birth Experience
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CONTACT
YOUR BIRTH EXPERIENCE
Please complete the online registration form. Once your registration information has been received, you will be sent an invoice.
Payment can be made by cash, check, or Paypal/Venmo. Payment must be received within 7 days of registration.
After registration and payment have been received, you will be contacted with more information about your YOUR BIRTH EXPERIENCE purchase.
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Indicates required field
Birthing Person
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First
Last
Birthing Person's Phone #
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Birthing Person's Email
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Partner
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First
Last
Partner's Phone Number
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Partner's Email
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Due Date
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Doctor or Midwife's Name
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Hospital/Birth Center/Home
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Ages of Any Other Children
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If you have other children, did you take childbirth classes during a previous pregnancy?
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Yes
No
If yes, where?
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Birthing Person
Age
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Occupation
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Educational Background
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Do you exercise regularly?
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Yes
No
If yes, what do you do?
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How would you rate your diet?
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Excellent
Good
Fair
Poor
How would you rate your ability to cope with stress?
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Excellent
Good
Fair
Poor
Would you like to breastfeed?
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Yes
No
What areas of pregnancy and/or childbirth do you especially hope to learn about in class?
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What are your plans regarding the use of pain relief medication for labor and birth?
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Any special information that you feel the childbirth educator should be aware of?
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Partner
Age
*
Occupation
*
Educational Background
*
Do you exercise regularly?
*
Yes
No
If yes, what do you do?
*
How would you rate your diet?
*
Excellent
Good
Fair
Poor
How would you rate your ability to cope with stress?
*
Excellent
Good
Fair
Poor
Would you like for the birthing person to breastfeed?
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Yes
No
What areas of pregnancy and/or childbirth do you especially hope to learn about in class?
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What is your understanding of the birthing person's plans regarding the use of pain relief medication for labor and birth?
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Any special information that you feel the childbirth educator should be aware of?
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YOUR BIRTH EXPERIENCE OPTIONS
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YBE Parent Guide
YBE Private Class
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