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Imprint | Data protection

Deutsch
Home Page
About me
Prices
Contact form
Film: East Meets West
- ENGLISH
- DEUTSCH
- SPANISH
- FRENCH
- ITALIAN
- PORTUGUESE
- CROATIAN
- RUSSIAN
- ARABIC
- CHINESE
- JAPENESE
- KOREAN
Imprint | Data protection

Contact form

Dear Parents,

I am happy to offer you personalized breastfeeding support. To help me assist you in the best possible way, please fill out my below contact form.

If the contact form won’t send, please send your information directly to:
kontakt@stillberatung-rosin.de

Name und Surname of the mother

Street and house number

Zip code

City

E-Mail-adress

Phone number

Name and surname of the child

Sex of the child

Male

Female

Birth

Vaginal

C-section

Breech birth

Facial presentation

Kristeller manouver

Vacuum extraction birth

Forceps

Umbilical cord around the neck

Received IV fluids during birth

Date of birth

Weight of birth in Gramm

Week of pregnancy at birth

Last weight in Gramm

Date of weight measurement

If applicable, how much formula do you approximately feed in 24h?

Summary of the issue

Opinion of the doctor

Opinion of the midwife

Pre-existing conditions/acute illness of the mother

Medication of the mother, for example contraceptive, since when?

Breast sugery

Augmentation

Reduction

Breast lifting

Pre-existing conditions/acute illness of the child

Medication of the child

Number of siblings of your baby

Maximum time of breastfeeding per child (in weeks, months, years)

I would like on a private bill

a home visit starting from 80 €, see prices

a telephone consultation starting from 10 €, see prices

The visitor of your website has agreed to the clause with the following text

I hereby agree that the data I have entered in the contact form may be stored electronically and processed and used for the purpose of contacting me and providing breastfeeding consultation. I am aware of the information regarding data protection, the use of my data, and my rights according to the Berlin Data Protection Act and Articles 15-17 of the DSGVO. I understand that I can revoke my consent at any time.

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Dear Parents,

I am happy to offer you personalized breastfeeding support. To help me assist you in the best possible way, please fill out my below contact form.

Name und Surname of the mother

Street and house number

Zip code

City

E-Mail-adress

Phone number

Name and surname of the child

Sex of the child

Male

Female

Birth

Vaginal

C-section

Breech birth

Facial presentation

Kristeller manouver

Vacuum extraction birth

Forceps

Umbilical cord around the neck

Received IV fluids during birth

Date of birth

Weight of birth in Gramm

Week of pregnancy at birth

Last weight in Gramm

Date of weight measurement

If applicable, how much formula do you approximately feed in 24h?

Summary of the issue

Opinion of the doctor

Opinion of the midwife

Pre-existing conditions/acute illness of the mother

Medication of the mother, for example contraceptive, since when?

Breast sugery

Augmentation

Reduction

Breast lifting

Pre-existing conditions/acute illness of the child

Medication of the child

Number of siblings of your baby

Maximum time of breastfeeding per child (in weeks, months, years)

I would like on a private bill

a home visit starting from 80 €, see prices

a telephone consultation starting from 10 €, see prices

The visitor of your website has agreed to the clause with the following text

I hereby agree that the data I have entered in the contact form may be stored electronically and processed and used for the purpose of contacting me and providing breastfeeding consultation. I am aware of the information regarding data protection, the use of my data, and my rights according to the Berlin Data Protection Act and Articles 15-17 of the DSGVO. I understand that I can revoke my consent at any time.

Captcha

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