Client Intake Form 

If you will be using me as your doula, please take some time to fill out and submit the client information form below prior to our first prenatal visit. This information is kept secure & confidential. We will have the opportunity to go over the information you've provided at our visit.

If you find a question does not apply to you, please answer with N/A; if you find that you don't have an answer for the more introspective questions, please consider allowing yourself to sit with the question to see if anything comes up. Those responses allow me to better understand what your needs & wants are in your birth experience & how I can help you achieve that.