CHILD BIRTH EDUCATORS ; Thank you for taking some time to let us know more about the work you do in Child Birth Education. The form should take no longer than 2 minutes to complete. First Name Last Name Work Telephone Mobile Your Email Company Physical Address (Work) Your Profession (Multiple sectors can be selected) CLINIC SISTERLACTATION CONSULTANTMIDWIFEDOULAGYNAECOLOGISTDIETICIANDERMATOLGISTOTHER: If other, please state here Your clients (please tick as many as appropriate): NEWBORN BABIESBABIES 0 – 1 YEARBABIES 1 – 2 YEARSTODDLERS 2 - 4CHILDREN 4 – 9 YEARSCHILDREN 10+ YEARSPREGNANT MOTHERSFIRST TIME PARENTSOTHER: If other, please state here You work predominantly in: GOVERNMENTPRIVATE PRACTICEOTHER: If other, please state here Your main areas of focus More then 1 sector can be selected): IMMUNISATIONSFEEDING (BREASTFEEDING AND/OR FORMULA)SKIN CONCERNSBIRTHDIET AND NUTRITIONPREGNANCYANTI-NATAL CLASSESPOST-NATAL CLASSESOTHER EDUCATION / CLASSESOTHER If other, please state here I agree to receive communication from Pure Beginnings YesNo Thank you for taking the time to complete the questionnaire.
