Homeopathic mixes to support women through pregnancy, childbirth and postbirth.

Pregnancy Health Form

Please answer the following questions in as much detail as possible, this will help us to ensure the Smooth Sailing Pregnancy Package is right for you. All your answers are completely confidential, if you have any questions about this form or would to discuss your pregnancy in more detail, please email me at hello@katysizeland.co.uk to arrange a 15 minute consultation with you.

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First name

Last name

Phone

Address

Birthday

Day

Month

Year

A bit about your pregnancy so far, please can we ask the first day of your last period or please indicate your pregnancy due date:

Is this your first pregnancy, if not please details previous pregnancies and birth experiences?

Is your pregnancy natural or IVF etc?

Any health present health conditions or history of miscarriages?

Are you taking any medications or supplements?

Any other details of your pregnancy you would like to tell us:

Would you like to book a full homeopathic consultation?

I confirm that I request Homeopathic pregnancy support. I give my permission to collect, handle and store my personal details for this purpose in accordance with the GDPR guidelines. I confirm that I understand the use and storage of data.

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Date

Day

Month

Year

Payment instructions will be provided once your pregnancy

health care form has been carefully reviewed.