Hypnobirthing Enrolment

Hypnobirthing Enrolment Form

Please read through this page carefully, then please fill in the Hypnobirthing Enrolment form and click the Submit button. You will receive an email from me confirming your details have been received. I will contact you using the phone number you provide below.

Class fee is per couple. Classes are held at Alpha Rahma Cottage in Atherton.

Group class runs over one full day 9.30am – 4.30pm
Group class fee = $280

Private class runs over 2 x 3 hr sessions, at times that suit you. Private class fee = $380

Name of Mother to be*
Please choose either the Group class option or the Private class option*
- Group Class $280
- Private Class $380
Preferred contact phone*
Preferred contact email*
Partners name
Mailing address including state and postcode
Is this your first baby?*
Ages of your other children?
Alternate phone number*
Emergency contact name*
Emergency contact phone*
Birthing assistant's name (if you have one)
Relationship of birthing assistant to you; ie friend, doula, sister, mother
Name of G.P*
Name of Midwife*
Birthing facility*
When is baby expected*
How many weeks pregnant will you be when you attend the class*
I wish to enrol in the class beginning (date)*
Are there any other concerns or experiences that you feel I should know about or wish to discuss?
Total
$ 0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Please check your email for confirmation.
Debbie will contact you on the phone number you added to your enrolment form.

Hypnobirthing Enrolment Form

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