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1:1 Membership Application
Assalamoe alaykum warahmatullahi wabarakatuh my dear sister,
Please fill in the form below as complete as you can, so that I have all the information I need to prepare for our call Insha Allah.
Let's start with your personal details
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How far along are you in your pregnancy?
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A
Planning - TTC
B
First trimester
C
Second trimester
D
Third trimester
E
Post partum
Is this your first birth?
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If you have given birth before, how was your experience(s)?
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What is drawing you to natural - or supported birth at this moment?
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How would you like your birth to feel?
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What do you feel you need the most right now?
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A
Education
B
Emotional support
C
Confidence & Trust
D
Guidance and clarity
E
Healing from a previous birth
Other:
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Do you have any medical conditions?
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How do you usually make important decisions?
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How do you process new information that challenges you in what you previously have learned?
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Do you feel committed to learning? Are you willing to actively participate, reflect and apply on what we work on together?
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Are you financially prepared to invest in this intensive 1:1 membership?
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If we are the right match, when would you like to start?
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Is there anything else you would like me to know about you or your situation?
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Do you understand that this support is educational and women centred, not medical care?
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Yes
No
I'm not sure
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