Doula in Minnesota - The Art of Birthing - register

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Registration

REGISTER

If you would like to contact me, please call, email, or fill out the form below.Mandatory fields are marked with *

Client Data

Your name*

Your age

Partner's name

Partner's age

Home Address*

City*

State*

Zip*

Email address*

Phone numbers (H)

(C)

(W)

Partner's phone numbers

Due Date

Other children

Number of all pregnancies

Have you had any complications in this pregnancy? (please give details)

Is there any health history that I should be aware of?

Where are you planning on having you baby?

Name or the clinic or doctor's practice

Midwife/Doctor's name

Why did you decide to hire a doula?

Who is going to be your support team besides me (the doula)?

Please name the three most important things for your for this birth

Where did you hear about my doula service?

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Vanessa Menanteau
Cellular: (651) 271 7361
Registration Form for Doula Services