Birth Client Intake Questionnaire  

Estimated Due Date *
Estimated Due Date
Tell Me About You
Name *
Name
Phone # *
Phone #
Partner's Name
Partner's Name
Partner's Phone Number
Partner's Phone Number
Address *
Address
Tell me about your birth (upcoming and/or past births)
Where do you plan on birthing?
Location Address *
Location Address
List the location where you'd like me to arrive once I get the call that you're in active labor.
People in Attendance *
List any people that will be attending the birth of your baby. Check any that apply.
Please briefly explain the expected birth dynamic. Will you have partner in the room and grandparents outside in the waiting room or will everyone be observing the birth? As much detail as you can give me here gives me an idea of the scene I'll be capturing upon my arrival.
Current pregnancy:
How is it progressing? Check any that apply.
Do you know your baby's gender? *
Transfer
If for any reason you are to be transferred from home to hospital or from one hospital to another for any reason, would you want me to:
Unplanned C-Section
In the event of an unplanned c-section I'll typically give the birthing partner my camera (on auto) and let him/her shoot the c-section to the best of their abilities. Then, once mama and baby are in a recovery room, I continue shooting for 1-2 hours to capture the baby's first moments earthside. Does this course of action work for you?
Past Labors*
If this is not your first labor, can you please describe how you past labor/deliveries have gone? Check any that apply.
pictures during your labor & delivery
What I would like photographed *
Check any that apply.
I want most of my pictures to be of: *