Name* First Last Email* Enter Email Confirm Email State*Please selectACTNSWVICNTQLDSATASWAPlease select which of the following best describes your current situation*Please selectMy partner is expecting (parent-to-be)I am expecting (parent-to-be)I am planning a pregnancyI am a family member of a parent-to-beI am a friend of a of a parent-to-beIs this you, or your partner's first pregnancy?Please selectYesNoDid you or your partner consume any alcoholic beverages during previous pregnancies?Please selectYesNoHow did you hear about Pregnant Pause? (tick all that apply)* Radio Television Online or social media Health Professional Word of mouth Other What motivated you to register for a Pregnant Pause? (please tick all that apply) I’m a mum-to-be and want to give my child the best possible start in life I want to find ways to support my pregnant partner or loved one I want to challenge myself to see if I can go without alcohol for nine months I want to set a good example and be a responsible role model I want to improve my health I want to save money I don’t drink alcohol anyway I have been, or know someone who has been, affected by Fetal Alcohol Spectrum Disorders My GP, midwife, or other health professional recommended I sign up I lost a bet and had to sign up I want to receive discounts and win prizes Other Join mailing listYes, I would like to join the Pregnant Pause mailing listNo, thank you.
Name* First Last Email* Enter Email Confirm Email State*Please selectACTNSWVICNTQLDSATASWAPlease select which of the following best describes your current situation*Please selectMy partner is expecting (parent-to-be)I am expecting (parent-to-be)I am planning a pregnancyI am a family member of a parent-to-beI am a friend of a of a parent-to-beIs this you, or your partner's first pregnancy?Please selectYesNoDid you or your partner consume any alcoholic beverages during previous pregnancies?Please selectYesNoHow did you hear about Pregnant Pause? (tick all that apply)* Radio Television Online or social media Health Professional Word of mouth Other What motivated you to register for a Pregnant Pause? (please tick all that apply) I’m a mum-to-be and want to give my child the best possible start in life I want to find ways to support my pregnant partner or loved one I want to challenge myself to see if I can go without alcohol for nine months I want to set a good example and be a responsible role model I want to improve my health I want to save money I don’t drink alcohol anyway I have been, or know someone who has been, affected by Fetal Alcohol Spectrum Disorders My GP, midwife, or other health professional recommended I sign up I lost a bet and had to sign up I want to receive discounts and win prizes Other Join mailing listYes, I would like to join the Pregnant Pause mailing listNo, thank you.
