Client Info Form – Doula Clients – Pregnancy & Birth Support, Online Prenatal Classes & Preparation

Privacy: Your information stays with us and is only used for us to contact you. We are vaults of privacy! It’s a pillar of this line of work.

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Thank you for your response. ✨

First and Last Name

Partner Name (if applicable)

Partner e-mail (if applicable and if they wish to be included in correspondence)

40-week date (a.k.a. due date)

Have you given birth before?

Phone Number - Mobile

Phone - Partner mobile (if applicable)

Phone - Home (if aplicable)

Home address

Mailing address with postal code, if different from home.

How you like to be called. I use a variety of inclusive terms when I teach and in public posts. I can be more specific with you. If you have nicknames, preferences, or preferred pronouns, please feel free to let me know here.

Do you have any allergies I need to know about?

Your medical care provider

Comments or questions