FREE OFFER to any health care provider experienced in assisting water deliveries: We will gladly list you or your birth facility in the Water Birth Resources List, totally free of charge. Please submit the following form (be sure to fill in all fields completely): Your name: Additional contact person: Organization/Facility (if any): Address: Phone: Fax: E-mail: Website: Our practice is: Individual Practitioner(s) Hospital Birth Center Other (please describe): Please describe the credentials and number of the practitioners in your group who assist waterbirth (note all that apply): How many MDs? How many CNMs? How many RNs? How many CPMs? How many LMs? How many DEMs/Direct Entry Midwives? How many Doulas? Other: We have been assisting waterbirths since: We have assisted approximately waterbirths from to . We have the following waterbirth facilities: We assist in home waterbirth: Yes No We have tub rentals available: Yes No We have seen the video, WATER BABY: EXPERIENCE OF WATER BIRTH, described in this website: Yes No We use video materials to educate clients about waterbirth: Yes No We own a copy of the WATER BABY video: Yes No Please share with us the feedback and satisfaction level of mothers and families whose waterbirths you have assisted. Please share your evaluation of waterbirth as a helpful method to assist with natural birth: Extremely satisfied Satisfied Not satisfied Is there anything else about your waterbirth work you'd like mentioned in your free listing? Additional comments: If your browser does not support forms, please email or snail mail the above information. If you need further help with your listing, contact Karil Daniels by phone, fax or email. Karil Daniels Point Of View Productions 2477 Folsom Street San Francisco, CA 94110 Email: karil@waterbirthinfo.com Phone: 01- 415-821-0435 Fax: 01 - 415-821-0434

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