Apply for the Integrated Birth Program Thank you for taking the time to fill out this application for the Integrated Birth Program. This application is 100% confidential and the questions help me understand your situation and needs better, however none are compulsory. I look forward to being in contact soon. Application Questions: Briefly describe your pregnancy in terms of health and emotional well-being; : Are you currently pregnant and/or have you recently given birth? Please state when you gave birth if you have: If you have given birth, briefly describe your birthing experience and three main areas you would have wished to be different: If you have given birth, briefly outline the three main things you are happy about in your birthing experience: How is your relationship with your baby?: How do you feel about mothering?: Why do you feel the Integrated Birth program may be helpful for you specifically?: What would you like to get from the Integrated Birth program?: Any additional questions or comments about the program?: Your Name (required) Your Email (required) Thank you for filling out this application!