Sacred Birth Support

New Client Intake

Please provide as much information as feels good! This is for me to learn about the most loving ways I might show up & be in service in your preparation.

Name

First Name

Last Name

Phone

(###)

###

####

Estimated Due Date

YYYY

If you have been pregnant or given birth before, please tell me a little bit about your experience.

Where has most of your knowledge of pregnancy/birth/postpartum come from so far?

Please list books, films, accounts and any childbirth classes

Where are you planning to give birth?

Who are you planning to have attend your birth?

What is your current state of health & wellness? What are some ways you are already taking great care of yourself?

What is / has been your relationship with your body?

Are you seeing any wellness practitioners for regular care?

Chiropractor, massage therapist, acupuncturist, naturopathic doctor

What role do you want your doula to fill? What is the most important thing you are looking for in a doula?

Do you have any spiritual beliefs or needs that you want your care team to know about so that they can be honored ?

Do you have any fears about this birth?

What is your absolutely ideal birth vision?

Describe what this looks and feels like for you

Do you plan on breastfeeding?

Do you have a plan for postpartum?

How did you hear about me?

Anything else feeling important to share?