Intake Form

Your Birth Journey Starts Here

Please fill out the Intake Form to the best of your ability.

This will help us get to know you and your needs, and will allow us to provide the best possible support throughout your pregnancy, birth, and postpartum journey. We look forward to working with you!

Intake Form for Bay Bee Bundle Doula Services

Personal Information

First and Last Name(pre-filled from booking form, please contact us if you need to update this information)

Preferred Name/Nickname and Pronouns

Email Address(pre-filled from booking form, please contact us if you need to update this information)

Phone Number

Address

Parking/Home Access

Partner's Name & Pronouns

Partner's Email

Partner's Phone Number

Emergency Contact

Pregnancy and Birth Information

Estimated Due Date(pre-filled from booking form, please contact us if you need to update this information)

OB Provider

Birth Location

Baby's Sex & Name

Your Date of Birth

Current Pregnancy

High Risk Issues

Previous Pregnancies and Births

Relevant Medical Conditions, Surgeries, or Procedures

What classes do you intend to take or have you taken in the past?

Besides your partner and doula, is there anyone else who will be part of your birthing support team?

Previous Trauma, Abuse, or Triggers

What do you anticipate will be your greatest challenge while in labor?

What do you anticipate will be your greatest source of strength while in labor?

Do you have an religious or cultural beliefs related to childbirth that your doula should be aware of?

Do you plan to breastfeed?

Do you have any concerns about breastfeeding and/or newborn care?

What kind of support do you expect you'll need postpartum?

Is there anything else you would like your doula to know about you and/or your partner?