Nane

STEP 1: PLEASE COMPLETE THIS INTAKE FORM TO REGISTER FOR AN IN PERSON PRIVATE CLASS.

First Name

Last Name

Phone

(###)

###

####

Estimated Due Date

YYYY

Preferred Date

Preferred Time

Additional Information

Please list 3 different dates and times in the near future that you could meet for an in-person private class and I will email you back with confirmation to meet at one of those times. (ex. July 4th @ 5PM, July 7th @ 6PM, July 8th, 10AM).

How did you hear about doula denise?

Step 2: Confirmation. You will receive an email or text from doula denise confirming date/time.

Step 3: Payment. Once date/time has been confirmed with doula denise, you can then proceed to pay for the class below.

Payment