Postpartum Wellness Assistance Form

If you need help during your postpartum period and cost or financial hardship is a barrier to your participation in the Postpartum Wellness Group, please complete the form below to enroll in our series free of charge.

The Postpartum Wellness Group is a four-week series held on Monday afternoons from 12:30-2:00 p.m. All participants are required to attend all dates in scheduled series. If for some reason you cannot make a session, please give us notice of your absence. No drop-ins will be accepted for this group.

If this is an emergency, please call 9-1-1. If you need local resources to therapist and other professionals, please contact us.


Name *
Name
Address *
Address
Phone *
Phone
Expected Due Date or Baby's Birth Date
Expected Due Date or Baby's Birth Date
Select which series you would like to attend. Class series are weekly on Mondays from 12:30pm-2:00pm. Check calendar for dates.