Lactation Intake | Beautiful Blessings

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Birth of Baby

Vaginal Birth

Cesarean Birth

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Epidural

Did baby experience any of these things

Birth Support

Postpartum Support

Lactation Support

Childbirth Education

Other

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Do you or your baby have any current heath concerns?

Other medications used during birth

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Contact our team using the form below. The information collected with this form will help us determine availability & fit.

Place of Birth (if applicable)

Hospital

Home

Lucina Birth Centre

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Which of these best describes you?

First Birth

Subsequent Birth

VBAC

Other

Care provider (if applicable)

Midwife

Obstetrician

Family Doctor

Other

Interested In

Birth Support

Postpartum Support

Lactation Support

Childbirth Education

Other

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