Kursi i përgaditjes për lindje

Birth Preparation Course Participation Form

First Name and Last Name

Date of Birth

In which week of pregnancy are you?

Phone Number

Email Address

Course Preferences:

Preferred time (select one)

Morning Afternoon Evening

Medical History

Do you have any medical history that we should know about?

YES NO

If yes, please tell us more

Additional Note:

Do you have any questions or special comments?

I confirm that the information provided is accurate and give permission for the processing of my personal data in accordance with the privacy policies.

I agree

Payment Method

Credit Card Bank Transfer Payment on Site

Birth Preparation Course Participation Form

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galley

galley

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