Class Report (English)

HypnoBirthing Class Report

This class report is a vital part of the HypnoBirthing® Institute's quality assurance and data collection programs. We will use the data you provide to determine how many mothers take HypnoBirthing classes each year and what percentage of parents complete the Course Evaluations and Birth Reports.

*Please complete these data sheets on a course-by-course or quarterly basis.

*Class Reports are required for your annual HypnoBirthing Practitioner certification renewal.

*Each course requires a separate report, whether you teach groups or private classes.

This is a secure website and all responses are encrypted for transmission over the internet in order to protect your privacy.

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* 1. Practitioner's name

First name

Last name

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* 2. Practitoner's email address:

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* 3. When did this series begin? (Date must be entered in the order below, i.e., O6/O1/2009)

Please enter:

Date

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* 4. When did this series end?

Please enter:

Date

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* 5. Was this course a refresher for someone who had previously completed the full course?

No, the course was not a refresher

Yes, one session as a refresher

Yes, two or more sessions as a refresher

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* 6. If this was a full course taught in fewer than 5 sessions, please indicate the reason.

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* 7. How many mothers in this class?

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* 8. Did all mothers finish the course?

Yes, all finished the course.

No, one or more dropped out because baby was born before series ended.

No, one or more dropped out for other reasons.

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* 9. If some mothers did not finish the series, please note how many and the reason(s) given.

Thank you for completing this class report. The information will be saved and logged automatically when you leave this website.

Question Title

* 1. Practitioner's name

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* 2. Practitoner's email address:

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* 3. When did this series begin? (Date must be entered in the order below, i.e., O6/O1/2009)

Question Title

* 4. When did this series end?

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* 5. Was this course a refresher for someone who had previously completed the full course?

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* 6. If this was a full course taught in fewer than 5 sessions, please indicate the reason.

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* 7. How many mothers in this class?

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* 8. Did all mothers finish the course?

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* 9. If some mothers did not finish the series, please note how many and the reason(s) given.

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* 10. In what country was the class taught?