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Class Date
Preferred Date
(required)
Select one option
Group – February 1/2, 2025
Group – March 8/9, 2025
Group – April 5/6, 2025
Group – May 3/4, 2025
Group – June 7/8, 2025
Private Class
Participant #1
Full Name
(required)
Number Phone
(required)
Email
(required)
Participant #2
Full Name
(required)
Number Phone
(required)
Email
(required)
Birth Information
Who is your provider?
(required)
Select one option
Midwife
Family Physician
Obstetrician
Where do you plan on giving birth?
Select one option
Home
Hospital
When is your Due Date?
Date (MM/DD/YYYY)
(required)
Other Information
Is there anything else you think we should know?
How did you hear about us?
(required)
Select one option
Provider Referral
Friend
Pamphlet
Internet Search
Other
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