New Registration Private

Registration for Private introductory session

This form is to be used for those interested in scheduling a private, individual introductory session. Please note that there is an additional cost for selecting this option.
After registering online, the Practitioner will contact you by email to set up your appointment. You may contact the Center by email or phone (816-858-0198) with any further questions. This session will be held via ZOOM.

The teaching of the Creighton Model system consists of an initial introductory session, and subsequent one-on-one follow-up sessions with a FertilityCare Practitioner. Please allow up to 90 minutes for the initial session. The cost of an individual Introductory Session is $60. More information on cost and follow up schedule can be found here. A sliding scale is available if needed.

Please note that signing up online gives us permission to contact you via email.

* Indicates required field

Name of Participant #1 *

First

Last

Name of Participant #2 *

First

Last

Marital Status *

Woman's Address *

Line 1

Line 2

City

State

Zip Code

Country

Man's Address *

Line 1

Line 2

City

State

Zip Code

Country

Woman's Age *

Man's Age *

Woman's Religion *

Man's Religion *

Woman's Phone Number *

Email *

Referral Source *

Reason for Attending *

If Engaged, when & where is your wedding? *

If intro is already scheduled, with who and when? *

Comments *

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Registration for Private introductory session

FCCKC