Fill Your Freezer - Intake Form Name Mother * First Name Last Name Name Partner First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Estimated due date: * Choose your meals * I have attached my nourishing Fill Your Freezer recipes list. Please select 3 savoury mains and 1 sweets/snacks and 2 types of cookie mixes and list below: I will then send you a full grocery l Do you have any dietary requirements? Please list for each family member and specify if anaphylactic. * What are your favourite foods and snacks? This helps me get an idea of you and what you love and i'll prepare some snacks to bring to my session :) * How are you feeling in your pregnancy? (Physically, Mentally, Emotionally) * What do you want your ideal Fourth Trimester look and feel like? When thinking about rest and quiet time, what do you enjoy most? * Long hot shower Soaking in a bath Eating nourishing food and snacks Getting out in nature/fresh air Reading a book Meditation A moment alone Journalling Sleep/rest Catching up with friend Other: Is there anything else you would like me to know about yourself, your family or your needs?Anything else you would like to share with me? * How did you find out about Empowered Birth and Beyond? * Thank you!
