Pilot tester application

Education | Inspiration | Support

07905-895 466

Abbots Langley

Thank you so much for your interest in being a pilot tester for the Your Birth, Your Way Programme! Please fill out this form to apply:

* Indicates required field

Name *

First

Last

Email *

Job title *

Your baby's estimated due date: *

Is this your first baby? *

Yes No

What are your reasons for wanting to do this pilot programme? *

On a scale of 1-10, how important is it to you to know all your options in childbirth? *

1 2 3 4 5 6 7 8 9 10

Are you willing to fill out a survey at the end of each week and be available to providing feedback? *

Yes No

Are you willing to be provide a recorded testimonial about your experience with this program? *

Yes No