Blissborn Intake Form

Please complete prior to attending Blissborn Class 1.

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Planned Place of Birth

Participation agreement: To be successful reaching my goals, I know it is important for me to–
*Practice daily. Having the birth I deserve takes preparation

*Recognize that my thoughts, feelings, images, and actions have a direct effect on my life and my baby’s birth. I take responsibility for my experience

*Be an active participant in my hypnosis experience and see myself as a partner in the transformative nature of this process(required)
I understand that the content of this series 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 midwife or doctor to answer my health or pregnancy related concerns. I agree that I will not hold the instructor or Blissborn responsible for any complications that could arise as a result of my pregnancy or birth. I understand that my childbirth educator does not guarantee a specific outcome for any student’s birth(required)