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Qualification Form For BirthSafe Consult Session
Thank you!
for your interest. Because our consulting sessions are highly tailored, we only accept women who meet specific criteria. Please complete the vetting questions below; successful applicants will be redirected to a link for the next steps.
Do you have 30mins to spare at least 4 times a week?
*
Do you have 30mins to spare at least 4 times a week?
A
Yes
B
No
Do you have access to internet and power?
*
Do you have access to internet and power?
A
Yes
B
No
Will you be able to get your recommended supplement?
*
Will you be able to get your recommended supplement?
A
Yes
B
No
Wil you be able to get the medication prescriptions if any apply to you?
*
Wil you be able to get the medication prescriptions if any apply to you?
A
Yes
B
No
Will you be able to do the recommended tests and screenings to determine safety of the pregnancy?
*
Will you be able to do the recommended tests and screenings to determine safety of the pregnancy?
A
Yes
B
No
Will you be able to show up for the live birth preparation sessions? (this is important)
*
Will you be able to show up for the live birth preparation sessions? (this is important)
A
Yes
B
No
Which one best describes you ?
*
Which one best describes you ?
A
IVF
B
First time mum
C
First trimester mum
D
Had previous miscarriage
Will you able to afford the 10% discounted fee from 32000 to 28800 so you can join the program and get your FREE consult?
*
Will you able to afford the 10% discounted fee from 32000 to 28800 so you can join the program and get your FREE consult?
A
Yes
B
No
Kindly provide your first name, phone number, and email(please be accurate because we will send information via your contact details)
*
*
*
Register