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Birth Intake Form

Prenatal Care

1. What prenatal care have you had up to the present?

Due Date and Location

2. Where are you planning to give birth and who is your OB or Midwife?

Birth Plans

3. Have you faced any opposition to your plans for your birth?


Doulas

4. Why do you want to have a doula present for your birth?

Expectations

5. What do you see as the duties or responsibilities of your doula? 

More about you

6. Please add any comments or  thoughts that you think might be important for me to know about you: 

"Celebrate Your Birth"

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