| Required info * |
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| Contact and Personal Information |
| Mother's Name * |
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| Partner's Name |
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| Address * |
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| Home Telephone * |
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| Handphone * |
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| email address * |
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| Pregnancy and Birth Details |
| Estimated Due Date * |
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| Place of birth * |
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| How many previous births have you had ? * |
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| What is your Obgyns Name ? * |
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| Services |
| Class package preferred |
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| Doula package preferred |
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| Breastfeeding support |
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| Others |
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| Class Schedule (pls check) |
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HypnoBirthing Classes: 22, 29 Apr, 6, 13, 20 May 2006, Saturdays 1-4pm @ Ang Mo Kio (this class is full) |
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HypnoBirthing Classes: 7, 14, 21, 28 May, 4 June 2006, Sundays 2-5pm @ Ang Mo Kio (3 spaces left) |
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HypnoBirthing Classes: 27 May, 3, 10, 17, 24 June 2006, Saturdays 2-5pm @ Ang Mo Kio |
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HypnoBirthing Classes: 7, 14, 21, 28 May, 4 June 2006, Sundays 2-5pm @ Ang Mo Kio |
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HypnoBirthing Classes: 11, 18, 25 June, 2 July 2006, Sundays 2-5pm @ Ang Mo Kio |
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HypnoBirthing Classes: 5, 12, 19, 26 August 2006, Saturdays 2-5pm @ Ang Mo Kio |
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HypnoBirthing Weekend Intensive: Suns, 23rd & 30th April 2006, 12-6pm (Ang Mo Kio) |
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HypnoBirthing Weekend Intensive: Suns, 6th & 13th August 2006, 12-6pm (Ang Mo Kio) |
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HypnoBirthing Weekend Intensive: Sat & Sun, 8 & 9th July 2006, 12-6pm (Jakarta) |
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*Free* Antenatal Taster: 9.30-11.30am, 30 Apr 2006 @ Julia Gabriel Centre, Forum Shopping Mall, Level 4, Studio 9 |
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| Confidential Information |
| Have you had any complications in this pregnancy you would like your doula to know about? (please describe) |
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| Is there anything else you would like your teacher or doula to know in confidence? |
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| What's important to you? |
| What are the three most important things for you for this birth? |
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Please choose which statement is closest to describing the sort of birth experience you would ideally like to have, assuming safety is your first priority |
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planning for a natural birth but will see what happens |
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totally natural and drug-free birth |
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planning an epidural |
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planning a caesarean |
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have absolutely no idea. |
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| What is the most important thing for you postnatally ? |
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How did you hear about Four Trimesters? |
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| Additonal Comments : |
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| Check one or more of the following: |
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Would you like to pay in full and get a FREE Mother's Intentions Book? (Not available with other discounts or promotions) |
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Would you like to use our easy installment payment scheme? |
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| Submitting your booking |
| We will send you a confirmation email within 3 days of receiving your booking together with an invoice for your payment. |
| Cheques should be made payable to Four Trimesters Pte Ltd and mailed to : |
| 235 Ang Mo Kio Ave 3 #07-1108 Singapore 560235. |
| For ATM or Internet Fund transfer: |
| Bank: United Overseas Bank (www.uob.com.sg) |
| Account No.: UOB #352-327443-9 [Bank Code: 7375; Branch Code: 001] |
| For Credit card payment, please click here |
| Your booking will be held for 7 days and will be confirmed on receipt of your payment. |
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| Thank you very much for your booking ! |
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