Student Info and Feedback Sheet

Names: _____________________________________________________________________________

Address: ____________________________________________________________________________

Phone Number: _______________________   Email Address: ______________________________

What’s the best way to contact you? __________________________________________

When is your baby due? ______________________   Is it a:  Boy              Girl        Still a Mystery

Where are you giving birth? __________________________ Dr’s name: _____________________

Do you have any special health issues with this pregnancy?

Why did you decide to take this class?

List three specific things you hope to learn in this class:

What books have you read about pregnancy and birth? Have you taken any other classes?

What do each of you do for work? Is Mom going back to work after the baby is born? When?

I’m here to answer whatever questions you might have about pregnancy, labor, birth, and parenting. Especially the ones that are bugging you, but you’re not sure to ask, those questions that you’re afraid are “stupid questions.” Please feel free to list on the back some of the questions you’ve been wanting to ask someone.