Primary Language *
What Hope for Women site do you prefer to be connected with? * Select Hope for Women Site Abbotsford Site (Abbotsford, Chilliwack, or Mission) Langley Site (Langley, Aldergrove, or Surrey) Prince George Site
Occupation *
Is it safe to contact you by phone, email or text? * Select Option Yes No
How would you prefer to be contacted by your mentor? * Select Preferred Contact Method Phone Text Email
Please share with us who is on your support team. This could be your partner, family, friends, social worker, your church, or your neighbours. *
Please Specify *
Please let us know your concerns and why you believe our program will be helpful for you. *
Please list your food allergies, sensitivities, or food concerns. *
What kind of pets do you have? *
Total combined income for all contributing adults in the home. * Select Income $0-14,000 $14,000-20,000 $20,000-25,000 $25,000-35,000 $35,000-50,000 $50,000-75,000 $75,000+
Do you have a partner? * Select Partner Status Yes, I have a partner No, I don't have a partner It's Complicated
Will your partner be involved? * Select Option Yes No He doesn't know about the pregnancy Unsure at this time
We know that some relationships are thriving while others can be quite messy. Please describe your relationship with your partner. *
Is there anything in particular that you would like your mentor to know beforehand? For example, previous birth experiences, worries/fears, triggers/traumas. *
