Birth Doula Intake Form - Birthing Person
Thank you for taking the time to provide your responses to these questions. If you don't have an answer for some questions, please take a moment to let the question sit with you and see if anything comes up. The responses that you give to the more introspective questions help us to form a better picture of what you are hoping for in your birth and how we can help you to achieve that.
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Client Section
Office Use Only
  • If you have concerns or questions about the terms outlined in the Letter Describing Doula Services, please contact us before agreeing.
  • It can sometimes make it hard for us to find you if you are registered under a different name that we don't know about. Even if you've done the paperwork for a name change, they will sometimes have your old name on file and, for some reason, use that, so it can be a big help to us to have it.
  • Please select a photo for us to add to your contact info in our phones. This way, when you call, we can see who it is; it helps to have a face for the name! Thanks.
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  • if you do not agree, please be aware that you will not receive any kind of updates or reminders about upcoming events, and will need to watch our Google calendar to keep track of these things (including cancellations), and let us know via text or email if you plan on attending any of the events.
  • Please let us know who to thank. Also, for every referral we confirm, $20 is donated to help low-income parents receive the prenatal care they need.
  • Please include any special instructions, such as buzzer number, parking tips or details about how to get to your home if it is at all difficult.
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    Please make it easy for us to get ahold of you should we need to by entering all applicable phone numbers. Thank you.
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  • If you are having multiples, please choose "other" and use the text field to detail your response. Please include info on what type they are (mono, di, tri combinations).
  • If you can't think of any fears, please tell me what things you may have heard from other parents about their birth that has made you feel badly for them.
  • Whether hospital, home or some other planet altogether, whatever feels true for you is the right answer.
  • Your doula can take photos of the labour and birth if you wish, circumstances permitting. If you aren't sure check out this article on labour photography, and let us know what you'd like to have captured: Options include: tender moments between you and your partner (there are several examples of this at the website above), the intensity of labour, birth team, environment, moment of birth, immediate postpartum.
  • Please tell us when you plan to stop working and how long you plan to be at home after the baby is born.
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