About Us

About you and your support system

First name

Last name

Birth partners name (if applicable)

Phone

Address

Guess date

Where are you planning to give birth? (Hospital, Birth Center, Home, Undecided) which unit if not at home.

Do you have any health conditions or pregnancy complications relevant to my care?

What are your biggest hopes or goals for this birth experience?

What are your biggest fears or concerns?

How do you envision the role of your doula during labor?

What time of day is best for your antenatal education visits? (Ideally, with your birth partner present)

between 10am-2pm

After 7pm

Weekends

Is there anything else that you think would be useful for me to know to best support you? (religious, dietary, spiritual, pronouns etc.)

How did you hear about me please?