I’m so excited to have you as a client. Before our first prenatal, please take some time to fill out this form. This will help me know how to best serve you, as well as helping any potential backup know a little about you in case they get called in. Thank you!

Something I can have for you at during or after your birth, that will survive in my car in any weather!
Music is one of my favorite coping tools, especially in early labor!
Whether it’s bubble-baths and true crime podcasts or exercise, how do you prefer to relax?
This is more a hint to start thinking about it than a serious question, but I have brought card games to births before. Video games, movies, dancing, and cooking might all be things to consider.
Selected Value: 0
0 is terrible, 10 is terrific
Selected Value: 0
0 is terrible, 10 is terrific
Selected Value: 0
0 is terrible, 10 is terrific
List any classes you’ve taken, blogs, books, or podcasts you’ve found helpful, etc
This can look so different depending on the client! Some clients like chatting over text every few weeks and others want to call after each checkup. There is no wrong answer!
Especially food allergies! I pack snacks to bring to births and I want to make sure you are safe!
I am not a medical provider, so please only share if you’re comfortable doing so.
This can include insertion of an IUD, a LEEP procedure, or a D&C procedure.
This can include a biopsy or cosmetic surgery- feel free to skip this question if you are not planning to breastfeed.
Feel free to skip this question if you are not planning to breastfeed.
This is different than a birth plan- what is your birth vision? You can be as specific or vague as you would like. Example: “I go into labor on a Sunday morning and have a lazy early labor time before going to the hospital in the afternoon. I have a quick, easy labor, and go home Monday afternoon.” Or, as another example: “Induction, epidural, music playing!”
Each partner has a different comfort level when it comes to birth support. Some love to be very hands on and involved, others wish they could wait outside. I never want to replace your partner so having an idea of their desired level of participation is very helpful. It’s totally okay if you don’t know or if they’re undecided.
Obviously this is subject to change, but knowing if you’re hoping for hands on support, guidance, help with hypnosis, or coaching you and/or your partner is a great starting point. It’s also totally okay if you don’t know yet!
This ties into both of the above questions but is a bit more specific, and I would love if your partner would answer this. Some partners want a coach, others want a teammate. I’m 100% on board with either of those and open to other options.
This can look like reminding staff of your preferences, helping with comfort measures during the birth of your placenta, breastfeeding assistance, and so many other things. It can even mean running to grab you a milkshake and feeding you.
I try to schedule our postpartum visit within the first two weeks of the birth. I’m happy to help with feeding concerns, babywearing education, light housework, and more. I also often give you some self care such as a foot rub.