WOMB SURROUND PROCESS workshop INFORMATION form

We recommend reading through each question prior to filling out the application. Some questions may prompt you to research information; and/or contemplate what resonates the most for a response.

YOUR RESPONSES WILL ONLY BE VIEWED BY MYRNA MARTIN AND WILL BE KEPT CONFIDENTIAL

Name *
Name
Birthdate *
Birthdate
professional information
Prenatal and birth therapy information
Note: Many of the following questions are intensely personal. Your responses will be kept completely confidential. Filling out this information form actually begins the work of the process workshop. If you are uncomfortable about responding to any of the questions please email or telephone me to discuss this.
Please check what you know or think applies to your birth history. My birth was: *
Please read and mark that you understand and agree with the terms of attending a process workshop: *