Booking Form

Doula Questionaire

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Birthing person Support Person Other

In order to better support you and perhaps have you think a little deeper about your upcoming birth, here is a little questionnaire that you can choose to answer as many of the questions as you feel comfortable to share.
It is beneficial for all attending the birth to have a think about these areas to better be present to the story unfolding with this baby. I look forward to your answers. Jo

Name *

First

Last

Email *

Phone Number *

Baby's guess due date *

Address *

Line 1

Line 2

City

State

Zip Code

Country

History

How did you feel when you first found out you were pregnant? How do you feel now? *

Previous Birthing History *

Previous Pregnancy History *

How did you feel about your menarche? What is your relationship with your bleeding cycle? *

If you know, how you were born? What is your birth story? And that of any older siblings. *

Is there anything in your history you feel I should know? *

relationship

How did you and your birthing partner meet? *

How would you describe your relationship with your birthing partner? *

Intentions

Any Previous or planned Childbirth Education? *

What is important to you about how you birth this baby? *

Share any Moments of challenge in your life *

Describe any interactions with the hospital system *

How would you best like to be supported by me? *

Is there anything else you would like to share? *

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