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Full Name (required)

Phone(required)

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Birth Companion/Partner Name

Expected Due Date (required)

Prefered Method of Contact (Choose one option)(required)

Email Text Message Phone Call

Class Method

How would you like to take the course? (Choose one)(required)

Virtually (via zoom meeting) In-person

In-person Class Locations

Sarasosta Class Series (@ Revitalize Chiropractic on Clark Road)

Private Classes-One on One (Subject to scheduling availability) Series 1: 1/13 thru 2/10, Friday Evenings from 6pm-9pm @ Sarasota (Revitalize Chiropractic) Series 2: 4/7 thru 5/5, Friday Evenings from 6pm-9pm @ Sarasota (Revitalize Chiropractic) Series 3: 6/2 thru 7/7, Friday Evenings from 6pm-9pm @ Sarasota (Revitalize Chiropractic) Series 4: 10/20 thru 11/17, Friday Evenings from 6pm-9pm @ Sarasota (Revitalize Chiropractic)

Online Group Class Via Zoom

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Series A: 3/19 thru 4/16, Sunday Afternoons from 3:00pm-5:30pm EST Series B: 5/4 thru 6/1, Thursday Evenings from 6:30pm-9:00pm EST

Where do you plan on birthing?

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Hospital Birth- with a Doctor Hospital Birth- with a Midwife Birth Center Birth Home Birth

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