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    Personal Information

    Expectant Mother’s Name:*



    Birth Coach/Partner/Husband/Other:*






    Class Date Registering For:*


    Planned Birth Place:

    Estimated Due Date:


    Please go to: for payment options and prices.

    **After the 1st class there will be no refunds.


    All information is strictly confidential. If you are uncomfortable answering any questions, please leave them blank.

    1. Do you have specific goals for the upcoming labor/birth/postpartum?

    2. In what areas do you feel you need the most information?

    3. What are your / coach's fears about the upcoming labor/ birth?

    4. (MOM) Do you _ to read (reading)?

    4. (COACH)Do you _ to read (reading)?

    5. Are you experiencing any of the common pregnancy discomforts? (ie:
    leg cramps, headaches, heartburn, backache, constipation, insomnia,

    6. Are you being treated for any more serious health conditions? (ie:
    high blood pressure, anemia, diabetes, epilepsy, asthma, etc.)

    7. Do you smoke cigarettes?

    8. Do you spend time with Someone who smokes?

    9. Do you take over-the-counter drugs or prescription drugs?

    10. Do you drink alcohol?

    11. Do you have a cat?

    12. Do you wear your seat belt?

    13. Do you lie on your back?

    14. What is your exercise routine?

    15. How do you rate your eating habits? (quantity/quality)

    16. What are your feelings about weight gain?

    17. Do you:

    18. Do you:

    What is your occupation?

    What is your coach’s occupation?

    19. What are your feelings about breastfeeding?

    20. Have you had breast surgery of any kind? If so, please explain.

    I understand that the information given in each class is of great importance to decisions we may be making concerning the health of mother and baby. Attending every class is ideal. If one of you can't attend, I encourage one of you to attend on your own or bring a substitute coach.

    Payment/Deposit Due with Registration or Paypal -

    Best Prenatal Videos

    "Liza offers so much more than prenatal yoga. She has a knowledge bank that goes beyond a prenatal fitness program. She guides you through poses that coach you for labor. After every class she shares birth wisdom, tips for pregnancy and labor. Her coaching and teaching are both compassionate and challenging." Tina M., Vista "Bottom line…I want to say thank you for your ‘birth wisdom notes from your prenatal yoga classes. If it was not for you, I would probably have been hooked up to an IV with an Epidural drip and in labor for 20 or so hours! So thank you again." Christy R., Carlsbad “…I also wanted to thank you for leading such a great yoga class and all of your birth wisdoms. I really believe that yoga helped me have the natural birth that I wanted. And I was only in labor 4 hours! … I will miss coming to your classes but will be back with baby number 2! Thanks again and take care, Marina"

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