Birth Education Registration Form Name-Surname / Occupation * Partner's Name-Surname / Occupation Date of birth * MM DD YYYY Mobile Country (###) ### #### Pregnancy week / Due date * Is this your first pregnancy? Yes No If not, previous type of birth Vaginal C-section Doctor's name * What are your thoughts about birth? What are your fears and worries about childbirth? * What kind of childbirth are you planning? Do you have any preferences for labor? If so what are those? * Are there any specific headlines you would like to learn in this course ? * How is your partner's approach about this course? Is s/he interested? Is s/he willing to attend? * Thanks for you registration.
