The Fit Doula
Your Pregnancy is a Wellness
Home
About
Meet Maddy
Testimonials
1:1 Training
Doula
REboot
On Demand
Contact
Navigation
Home
About
Meet Maddy
Testimonials
1:1 Training
Doula
REboot
On Demand
Contact
Client Intake Form
Pregnant Persons Name
*
First Name
Last Name
Email
*
Phone Number
*
(###)
###
####
Partner's Name
*
First Name
Last Name
Partner's Email
*
Partners Phone Number
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What’s the best way to contact you?
*
Estimated Due Date
*
MM
DD
YYYY
Mom’s Age
*
Where are you planning to give birth?
*
Who is your OB or Midwife?
*
Do you feel comfortable with your chosen birth location and doctor or midwife?
*
Have you had any previous pregnancies births including miscarriages and abortions? (please describe)
Have you experienced any problems or complications with this pregnancy so far?
What are your primary wishes for your birth?
Have either of you witnessed a birth? What does a natural birth mean to you?
What books have you been reading or films have you been watching about childbirth and parenting what have you liked the most?
Do you or your partner have a history with depression or anxiety if so what methods have you explored in the past to work through with those feelings?
Do you have any pets?
Do you have any dietary preferences or restrictions?
Do you have any house rules or preferences we should be aware of?
Are you interested in learning about Postpartum Doula services?
How did you get connected with me?
Is there anything else you would like me to know about you or your family?
Thank you!