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If you have a spouse or birthing partner, please include their information.

Your Name

First Name

Last Name

Your Email

Your Phone

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Partner's Name

First Name

Last Name

Partner's Email

Partner's Phone

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Due Date

MM

DD

YYYY

Please name your OB practice and doctor.

Where are you planning on giving birth?

If you are undecided, please describe the options you are interested in below.

Hospital

Birth Center

Home Birth

Please list which hospital, birth center, or other location.

Questions?