Registration - Postpartum Visits Mother's Name* First Last Mother's AgePartner's Name First Last Partner's AgeAddress Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Email* Baby's Name First Last Baby's AgeBaby's SexMaleFemalePlease identify how much you trust the following resources for reliable prenatal information.Public health unitDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowPrimary care providerDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowHealth Canada InternetDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowChatrooms, discussion boardsDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowFamily, friendsDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowSocial media (Facebook, Twitter, blogs)Do not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowBooks, magazines Television, radioDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowOther resourcesDo not trust at allTrust slightlyTrust moderatelyTrust completelyDo not knowYour PreferencesCheck all the boxes that are applicable. Feel free to choose as many topics as you feel to get support on. Remember that for multiple topics chosen you may require multiple visits to address each of your needs. I will be with you for 30 minutes during each visit. If you require additional visits and would like to discuss multiple topics, please choose the numbers of visits accordingly. Topics that you would like to discuss in the group session Select All Emotions associated with new motherhood Your relationship with your baby Changes in lifestyle and relationships Expectations of oneself as a new mom Breastfeeding support Baby’s Temperament Baby’s play Introducing solid feeding Traveling with your baby Baby: Eating Baby: Sleeping Baby: Crying Mom: Eating Mom: Sleeping Mom: Crying Understanding your baby’s cues Returning to work or staying at home? Balancing personal and professional options. Postpartum depression Infant Feeding (Breast or Bottle) Colic and Crying Baby’s Sleep Patterns Co-sleeping Bed Sharing Baby’s Health Doctor’s visits and what to expect Immunization information Mommy’s health Mommy’s health – weight loss Parental time – making time for each other Post-Baby Exercising Attachment Infant Development and Stages Community Resources Available Social Groups – Counselling Social Groups for Mom and Baby Social Groups – Exercise Other OtherPlease explain:What is the main reason you are joining a mommy class?List any resources or topics you are interested in, or would like to learn more about:Are there any class topics you haven't seen on the list, that you would like to include?Preferred Day and TimePlease select your preferred days (please note that the visit will take place on the following week after payment is made and not during the week that you have completed the registration.) You will receive confirmation of the specific date for your postpartum visit. Please wait for this confirmation before making it final in your schedule to ensure availability. Each paid session is for 30 minutes. If you require 60 minutes, it will be considered two sessions. Thursday7:00pm7:30pm8:00pmFriday7:00pm7:30pm8:00pmSunday7:00pm7:30pm8:00pmNumber of Visits1 visit3 visits5 visits10 visitsPlease note that all visits are 30 minutes each.QuantityPlease enter a number greater than or equal to 1.Subtotal $ 0.00 CAD HST $ 0.00 CAD Total $ 0.00 CAD Free Parking AvailableCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.