Online Registration


The following form is to register for your preferred series.


If you prefer old-fashioned paper (i.e. not online),

let me know and I can email a document.


If you have questions about these questions,

please read the Privacy Policy first (see below);

you can contact me at 416 255 8333.


ChildbirthJoy Prenatal Hypnosis Registration

Please note that all fields followed by an asterisk must be filled in.
partner
husband
wife
other (please specify)
Yes
No
Registered Midwife
Family Practice Physician
Obstetrician
Other
Yes
No
Not Discussed
Yes
No
Other
Home
Hospital
Toronto Birth Centre
Other
Yes
No
Not decided yet
Yes
No
Have not decided yet
epilepsy
mental illness requiring psychiatric care
other
none
Yes
No
Do not know
No
Diclectin (or other anti-nausea)
Thyroid Rx (or other)
Other
Yes
No
Other
Hypnosis
Meditation
Yoga
None
Other
Yes
No
Not sure
Yes
No
Not sure
Yes, sign me up!
No thanks
Maybe later
email transfer $372.90
email transfer: deposit ($141.25 now) & balance ($231.65, 2 weeks before the series)
Mail: one cheque for $372.90
Mail: two chqs: deposit of $141.25 dated now and balance of $231.65 dated two weeks prior to start of series
$389.85 by PayPal (this includes a service charge of $15)
$389.85 by credit card (this includes a service charge of $15)
Other (please indicate)
Yes
No


By completing the Intake Form, you agree to the following Terms and Conditions and Privacy Policy:

Please take a moment to review this link:

Privacy Policy

Thank you!




Socializing...




Relaxation Evening:
General

Tuesday May 30

7.30 pm to 9 pm

Home office (west end Toronto) location.

No charge to attend, but reservations are required.

416 255 8333



Relaxation Evening: 
Fertility Focus

Monday May 15

or

Monday June 12

6.50 to 8.30 pm

ALIVE Holistic Health

Carlton and Yonge

No charge to attend, but reservations are required.

This evening is open to those with fertility challenges.

Whether planning natural conception, IUI or IVF, this is a time for you to just relax and feel good.