Birthrites: Healing After Caesarean.

This nomination form is for our annual awards, coinciding with the
celebration of National Caesarean Awareness day.
We present awards to an Obstetrician, Doula and Midwife
who have provided excellent service in evidence-based,
woman-centred maternity care.

It is our chance to recognise these people who make
such a difference to our birthing experiences.

Please copy the form below into an email,
or a word document which you can attach to an email,
and email it to us at:
Birthrites

Alternatively, you can print off this page and post it to us at:
Birthrites
PO Box 62, Subiaco, WA, 6904

*****

Midwife:

Name: _________________________________________________________________________

Address Details: ________________________________________________________________

State: _________________________ Phone Number: __________________________________

Your Comments: ________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

*****

Obstetrician:

Name: _________________________________________________________________________

Address Details: ________________________________________________________________

State: _________________________ Phone Number: __________________________________

Your Comments: ________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

*****

Doula:

Name: _________________________________________________________________________

Address Details: ________________________________________________________________

State: _________________________ Phone Number: __________________________________

Your Comments: ________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

*****

Your Name: _____________________________________________________

Address Details: _________________________________________________

State: _____________ Phone Number: _______________________________

Email Address: __________________________________________________

Thankyou!
*Note - You can nominate for all 3 categories, or just one...
Whichever you feel most strongly about
- Your choice!
Your privacy will be ensured
(i.e., we won't tell the nominee who nominated them!)