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Last name and first name*

Date de la séance*

Date of the session

Full mailing address*

E-mail*

Phone number*

baby's date of birth*

expected date of birth*

Baby's first name, gender, birth weight and height*

First names and ages of other participants in the session*

feeding with milk

possible need to heat a bottle

GERD

jaundice

separation of mother and child at birth

item(s) that you think are important to report?

colors you don't like

If possible, you would prefer swaddling.

I authorize the publication of photos and/or videos (which gives the right to 2 photos to choose from in addition to the 4 already in the offer)

I have read the T&Cs (General Conditions of Sale) and the fee of 120 euros to be paid for the session (or gift voucher)

By clicking on "FINISH" you will be redirected to the T&Cs

questionnaire