Private Services

Private Services Registration

Contact Information

Name*

Birth Partner Name

Estimated Due Date*

Planned Place of Birth

Address*

Phone Number*

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. View our terms of service & privacy policy.

Email*

Additional Requests

Services

Private Services*

Private One-Day Thoughtful Birth Intensive ($500)
Prenatal Consultations ($200)
Virtual Birth Doula Support ($500)

Total

$0.00

Terms & Agreements

Terms & Agreements*

In the event of illness on the part of the instructor, a birth, or inclement weather, services may be rescheduled.

By completing this online registration form, you are agreeing to pay the total amount due for the services selected above. Once payment is received, no refunds will be issued and all sales are final.

For questions, please contact Bloom Birth Concierge at (412) 330-1159 or [email protected].

I have read and agree to the terms above.

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