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City, Province, Country:

How many weeks pregnant are you?

What is your anticipated due date?

Are you considering Home Birth? Water Birth?

Have you engaged any other forms of medical support for your pregnancy?

What physical symptoms are you experiencing currently and/or recently?

What emotions are you experiencing currently and/or recently?

Do you have a loving, supportive circle of friends and/or family?

Do you have someone (a partner or friend) willing to support you - at least spend time with you intermittently - as you walk through this journey of pregnancy and birth?

Do you have any other concerns, questions, or comments you would like to share?

More in-depth questions will follow shortly, in the intake forms.

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