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First name
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Last name
*
Email
*
Phone
*
Address
*
Current age
*
Partners name (optional)
Estimated Due Date
*
Month
Day
Year
Is this you first baby or have you given birth before?
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Are you planning:
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Are you preparing for a VBAC?
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What drew you to seek this type of support?
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How are you currently feeling about your upcoming birth?
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Excited
Calm
Nervous
Fearful
Overwhelmed
A mix
Other
Do you have any past birth experiences you would like support in processing or healing from?
Which of the following resonate with you? (Select all that apply)
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I want a more natural, intuitive birth experience
I feel called to prepare on a deeper emotional/energetic level
I value holistic or alternative approaches
I am open to energy healing
I want to feel more confident and connected going into birth
I am ready to release fear or past experiences
On a scale of 1–5, how committed are you to preparing intentionally for your birth? (1 = unsure, 5 = fully committed)
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What does your ideal birth experience feel like to you?
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Are you open to exploring emotional, energetic, and subconscious factors that may influence your birth experience?
Which support option are you most interested in?
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Birth Prep - Everything But the Birth
Virtual Full Support
In-Person Full Support
Not sure yet
Investment for these experiences ranges from $1,047–$1,947. A 50% deposit is required to reserve your space, with flexible payment plans available. Are you prepared to make this level of investment in your birth experience?
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Yes, I am ready
I would like a payment plan
I’m still exploring
When are you hoping to begin support?
As soon as possible
Within the next few weeks
Just exploring
Would you like to schedule a free consultation? If so, what type?
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Yes, In-person (Rapid City, SD)
Yes, Virtual phone/video
No
If yes, please share some days/times that may work for you
Submit
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