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Newborn Form
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First Name
*
Last Name
*
Email
*
Phone
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Have you had the baby? If so when?
If not, when are you due?
Did anyone refer you, if so, who?
What's the baby's gender?
We highly recommend an in person consultation, what's your weekday availability?
Prove you're human: what is 7 + 3 equal?
*
If you are a human seeing this field, please leave it empty.
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