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.

First and Last Name(required)

Partner Name (if applicable)

Email(required)

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

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

Have you given birth before?(required)

Phone Number - Mobile(required)

Phone - Partner mobile (if applicable)

Phone - Home (if aplicable)

Home address(required)

Your medical care provider(required)

Other prenatal care providers(required)
Massage Therapist Chiropractor Naturopath Physiotherapist Hypnotherapist Osteopath Mental Health Counsellor Other None

Do you have any allergies I need to know about?(required)

Comments or questions

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