QUESTIONNAIRELet’s get to know you better to serve you better! This form should only take you a few minutes to fill and if you have any questions please do not hesitate to reach out First name - How would you like to be called? * How do you identify? * He/Him She/Her They/Them How do you identify if other? Email * Age * below 13 13 - 15 16-18 19-25 26-30 31-35 36-40 41-45 46-50 50-55 56 and above Are you planning a pregnancy? * Yes No Still Unsure Are you pregnant? * Yes No If so, how many weeks pregnant are you? N/A week 1 week 2 week 3 week 4 week 5 week 6 week 7 week 8 week 9 week 10 week 11 week 12 week 13 week 14 week 15 week 16 week 17 week 18 week 19 week 20 week 21 week 22 week 23 week 24 week 25 week 26 week 27 week 28 week 29 week 30 week 31 week 32 week 33 week 34 week 35 week 36 week 37 week 38 week 39 week 40 week 41 week 42 and above Are you post-partum? * Yes No If so - how many weeks/months/years post-partum are you? N/A week 1 week 2 week 3 week 4 month 1 month 2 month 3 month 4 month 5 month 6 month 7 month 8 month 9 month 10 year 1 year 2 year 3 - 5 year 6 - 8 year 9 - 11 year 12 and above If postpartum what type of birth(s) have you had? Caesarean birth Vaginal birth Vaginal birth after a caesarean birth Caesarean birth after a vaginal birth What topics would like us to discuss? * Baby and pets Baby and siblings Breastfeeding Burn-out Endometriosis Family relationships Fertility - Conception Genital health Grief Herbal remedies Hypno-birthing Juggling a career and being a parent Meditation Mental health Morning sickness Nutrition PCOS Pelvic floor health Preparation to labour Pregnancy and Covid-19 Reproductive justice Sex pregnancy and post-partum Sleep (for parents and baby) Weight-gain Weight-loss Other What topics would like us to discuss - Other? Thank you for submitting your form!We will read it with attention and craft your bespoke mindful guide to pregnancy and post-partum with care.Talk soon!With all my dedication, Nada