Calmbirth Booking Form

AVAILABLE DATES 2025:

(consecutive Sundays)

JUNE 8 & 15 2025

JULY 20 & 27 2025

LOCATION:

The Caring Collective, Mount Annan

$595

Date of Course*

Please only select the first date of the course you wish to attend

Full name*

Support / Partners Full name*

Phone*

Email*

Address*

Dietary Requirements for Morning Tea

Mothers Occupation*

Support person / Fathers occupation

Name of Health Fund*

Do either of you have specific fears or phobias? (e.g. water, heights, etc.)*

Are you or your partner currently being treated for any medical or psychological issues? If you are under the care of a psychologist or psychiatrist please provide a letter of approval for you to attend the Calmbirth course.*

Do you take medication/s on a regular basis? If yes, what medications do you take?*

Do you or your partner have a disability? If so, what kind of disability?*

Is this the birth of your first child / second / third etc?*

Estimated Due Date?

Model of Care*

Private Midwife

Private Obstetrician

Midwives - hospital

Midwifery Group Practice

Other

Name of Care Provider if known?*

At which hospital or location will you give birth?*

What are your feelings about the birth prior to commencement of the Calmbirth® class? Is there any specific fear you have regarding the birth or becoming a parent?*

What would you like to get out of the Calmbirth program?*

Do you have any other information that may be helpful for your Educator to know about you?

How did you hear about Calmbirth Classes?*

Word of Mouth

Care Provider

Social Media

Do you give permission to Calmbirth to use any of your photos, testimonials and birth stories for print and online marketing?*

Yes

Contact

©2021 by HELD by Jess.
Photography copyrighted - Rebecca Laurance Photography, Studio Jade Photography & Alexandrana Penelope Photography

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