[et_pb_section fb_built=”1″ admin_label=”consult inquiry” _builder_version=”4.27.4″ _module_preset=”default” custom_padding=”||54px|||” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][et_pb_row _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_contact_form email=”tonya@bumptobabypostpartum.com” success_message=”Thank you for your inquiry, I look forward to connecting with you soon. If your inquiry is urgent, please call me at (517) 300-8700. ” submit_button_text=”Submit ” _builder_version=”4.27.4″ _dynamic_attributes=”link_option_url” _module_preset=”default” _unique_id=”73c3cbff-f49d-4fd0-b7dd-5371011169b4″ link_option_url=”@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9wYWdlIiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjI1OSJ9fQ==@” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][et_pb_contact_field field_id=”Name” field_title=”Full Name:” _builder_version=”4.27.4″ hover_enabled=”0″ global_colors_info=”{}” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off” sticky_enabled=”0″][/et_pb_contact_field][et_pb_contact_field field_id=”Pronouns” field_title=”Preferred Pronouns (Optional)” field_type=”select” select_options=”%91{%22value%22:%22She/Her/Hers%22,%22checked%22:0,%22dragID%22:-1},{%22dragID%22:0,%22value%22:%22He/Him/His%22,%22checked%22:0},{%22dragID%22:1,%22value%22:%22They/Them/Theirs%22,%22checked%22:0},{%22dragID%22:2,%22value%22:%22She/They%22,%22checked%22:0},{%22dragID%22:3,%22value%22:%22He/They%22,%22checked%22:0},{%22dragID%22:4,%22value%22:%22Prefer not to say%22,%22checked%22:0},{%22dragID%22:5,%22value%22:%22Other%22,%22checked%22:0}%93″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”Location” field_title=”City/County” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”Number” field_title=”Telephone Number: ” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”Email Address:” field_type=”email” _builder_version=”4.27.4″ global_colors_info=”{}” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”OB” field_title=”Main Provider (OB/Midwife):” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”EDD” field_title=”Estimated Due Date / Date of Delivery:” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”clinic” field_title=”Planned location for delivery: ” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”Services” field_title=”Interested Services:” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22Bereavement Support%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Birth Plan Education%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Pregnancy/High-Risk Support%22,%22checked%22:0,%22dragID%22:1},{%22value%22:%22Birth Doula%22,%22checked%22:0,%22dragID%22:2},{%22value%22:%22Postpartum Care (daytime)%22,%22checked%22:0,%22dragID%22:3},{%22value%22:%22Overnight Care%22,%22checked%22:0,%22dragID%22:4},{%22value%22:%22Lactation Support%22,%22checked%22:0,%22dragID%22:5},{%22value%22:%22Virtual Support%22,%22checked%22:0,%22dragID%22:6},{%22value%22:%22Newborn Care Education/Support%22,%22checked%22:0,%22dragID%22:7},{%22value%22:%22Other/Multiple Serivces%22,%22checked%22:0,%22dragID%22:8}%93″ _builder_version=”4.27.4″ _module_preset=”default” form_field_background_color=”rgba(0,184,209,0.56)” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”Medical” field_title=”Medical History: ” field_type=”checkbox” checkbox_options=”%91{%22dragID%22:8,%22value%22:%22Adolescent Pregnancy (10 – 19 years old)%22,%22checked%22:0},{%22dragID%22:1,%22value%22:%22Autoimmune Conditions (Lupus, MS, Etc)%22,%22checked%22:0},{%22value%22:%22Cardiac Conditions%22,%22checked%22:0,%22dragID%22:-1},{%22dragID%22:9,%22value%22:%22Geriatric Pregnancy (>35 years old) %22,%22checked%22:0},{%22dragID%22:0,%22value%22:%22Gestational or Type 1/2 Diabetes%22,%22checked%22:0},{%22dragID%22:2,%22value%22:%22Hypertension (Chronic or Gestational)%22,%22checked%22:0},{%22dragID%22:3,%22value%22:%22Preeclampsia %22,%22checked%22:0},{%22value%22:%22Premature Delivery (<37 wks)%22,%22checked%22:0,%22dragID%22:5},{%22dragID%22:6,%22value%22:%22Multiples (Twins, Triplets, etc)%22,%22checked%22:0},{%22dragID%22:7,%22value%22:%22Miscarriage History (>2 )%22,%22checked%22:0}%93″ _builder_version=”4.27.4″ _module_preset=”default” form_field_background_color=”rgba(175,124,152,0.61)” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”contact” field_title=”Preferred method of contact:” field_type=”select” select_options=”%91{%22value%22:%22Email%22,%22checked%22:0,%22dragID%22:-1},{%22dragID%22:0,%22value%22:%22Telephone%22,%22checked%22:0},{%22dragID%22:1,%22value%22:%22Zoom appointment %22,%22checked%22:0}%93″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”timeline” field_title=”Where are you in this journey? ” field_type=”select” select_options=”%91{%22value%22:%22I would like to hire a doula ASAP.%22,%22checked%22:0,%22dragID%22:-1},{%22dragID%22:5,%22value%22:%22I would like services to begin within one month.%22,%22checked%22:0},{%22dragID%22:6,%22value%22:%22I am currently interviewing doulas.%22,%22checked%22:0},{%22dragID%22:7,%22value%22:%22I am new to doula services and would like more information please. %22,%22checked%22:0},{%22dragID%22:8,%22value%22:%22I would like to hire a doula when I begin my third trimester.%22,%22checked%22:0},{%22dragID%22:9,%22value%22:%22I only want postpartum services. %22,%22checked%22:0},{%22dragID%22:10,%22value%22:%22I am anxious and welcome all the information now in my second trimester.%22,%22checked%22:0}%93″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”message:” field_title=”What type of support do you feel you need most? (emotional, educational, advocacy, physical):” fullwidth_field=”on” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][et_pb_contact_field field_id=”Permission” field_title=”Do you grant permission for me to contact you via email, telephone, or audio/video communication?” fullwidth_field=”on” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][/et_pb_contact_field][/et_pb_contact_form][/et_pb_column][/et_pb_row][/et_pb_section]
English