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MY PHILOSOPHY
I believe in providing care that is respectful, individualized, and gentle
BIRTH IS A TRANSFORMATIVE EXPERIENCE THAT SHOULD BE SUPPORTED IN A INDIVIDUALIZED AND LOVING MANNER WITH TRUST IN THE PROCESS
Contact Alicia of La Rosa Midwifery Inc.
Because I offer a variety of services from pre-conception to birth, postpartum and beyond this form is to let me know how I can serve you best.
Please fill it out as fully as possible.
For more information and to schedule a free consultation please fill out the form below
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Indicates required field
Name
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First
Last
Email
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Phone Number
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Home address and/or area you live in
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Preferred contact method
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Phone
Email
Text
Are you a new or previous client?
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Are you currently pregnant?
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Yes
No
Maybe
First day of your Last Menstrual Period?
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Estimated Due Date
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I would like a consultation to discuss:
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Home Birth
Prenatal Care
Well woman/ Well Person care
Pre-conception counseling
Prenatal Nutritional counseling
Placenta Preparation
Belly Binding/ Postpartum healing services
Other
If you chose Other for consultation reason please specify here:
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Please tell me a little about yourself, your specific situation and why you would like a consultation:
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Which number pregnancy is this?
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Have you had a ceserean section with any previous pregnancies? If so how many?
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How did you hear about La Rosa Midwifery?
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Google search
Yelp
Social media
Referral
Other
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Home
Midwifery Services
About
Testimonials & Reviews
Belly Binding
Finances & Insurance Billing
Blog
Recommendations
Contact Alicia
