Please complete this form in its entirety so I can be prepared to meet your unique needs.
The HypnoBirthing® Institute may contact you for quality assurance and research purposes. If you consent to be contacted now, please note that you are free to change your mind at any time. Be assured that we will not share your personal identifying information with anyone outside the HypnoBirthing® Institute for any purpose. Thank you for your help in collecting data to support the growth of HypnoBirthing®.
I hereby state that I am enrolling in the HypnoBirthing® class of my own free will and understand that this is a program designed to teach me to use my own natural abilities to bring my mind and body into a state of relaxation. I further understand that the content of these classes is in no way intended to be represented as medical advice nor as a prescription for medical procedures. I am aware that I should seek the advice of a healthcare provider to answer any health-related or pregnancy-related issues surrounding my pregnancy, my labor, or my birth.
I, therefore, agree that I will in no way hold the instructor of the HypnoBirthing® classes, or the HypnoBirthing Institute®, its owner, or its representatives responsible for any special circumstances that could arise as a result of my pregnancy, my labor, or the birth of my child; and I agree that neither I nor any member of my family will make any claim or initiate any suit against any of the above-named parties now or at any time in the future.
By submitting this form, you agree to receive communications from Birthing Peace, LLC. Your information will never be shared with any other provider or company and you may unsubscribe at any time.
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