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Contact Us

Your Name*

What kind of care are you seeking?

Email Address*

Phone*

EDD or DD?

Location/Hospital where delivery will be*

Any pregnancy complications or concerns?

Have you given birth before? if yes, how many and weeks gestation?

Any other notes for me..

Contact me with any questions or concerns that you may have. 


I look forward to talking with you and getting to know you. 


I provide free consultations for one hour (virtual or in person) for birth and postpartum care. This intake form helps me understand some information about you and your family.


I'll get back to you within 48 hours. 

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