New Client BIrth Questionnaire

Estimated Due Date *
Estimated Due Date
Let's Get to know you
Name *
Name
Phone Number *
Phone Number
Alternate Phone
Alternate Phone
Partner's Name *
Partner's Name
Partner's Phone
Partner's Phone
Address *
Address
Tell Me About Your Birth(s)
Past & Present
Location Address *
Location Address
People in Attendance *
List any people that will be attending the birth of your baby. Check any that apply.
Current Pregnancy *
Check any that apply.
Past Labors *
If this is not your first labor, please describe past labor/deliveries. Check any that apply.
If for any reason you are transferred from home to hospital or from one hospital to another, would you want me to:
Photography during Labor & Delivery
What would you like photographed? *
Check any that apply.
What is most important to you? *
Social Media Sharing
Social media is a huge tool for marketing and sharing my work. I would love the opportunity to share your images in a modest manner, but want to leave the decision up to you.
Are you okay with me posting your birth story on my blog? *
Blogs are usually published within 4 weeks and can be as non-identifying as you would like.
Are you comfortable with me posting non-identifying social media updates about your labor & delivery experience? *