Birth Doula Client Questionnaire

Any other name that you do not use but might be on a driver's license or other legal documents. This is for use in case of emergency.
Whoever your main support person in your labor will be. Mother, father, friend, etc.
This should be the address that you want Abbey to support you in prenatal visits, labor, birth, or postpartum visits.
This should be the best address to send invoices, receipts, or other information during your pregnancy, labor, and postpartum period.
This is the primary number that Abbey will be in communication with you for your pregnancy, labor, and postpartum period.
This should be the number of whoever is your primary support person during pregnancy, labor, birth, and postpartum. For instance a spouse, relative, or friend.
Please include any miscarriages or stillbirths.
This is the number of living children you have delivered.
This allows me to be aware of any caution surrounding medical pain management that you might want.
include any negative or positive experiences in hospitals or trauma.
This is a good place to note anything you desire to be a part of your birth that is not traditional or commonplace.
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