Free Birth Doula Client Intake Form: 2024 Updated

Pregnancy and Postpartum Care for Everyone

Creating comprehensive and organized client forms is crucial for a Birth Doula to gather essential information and provide the best support. Here are some suggested forms you might consider using:

  1. Client Intake Form:
    • Contact information (name, address, phone, email)
    • Partner/support person information
    • Obstetrician/midwife details
    • Medical history (including previous births)
    • Birth preferences and goals
  2. Prenatal Questionnaire:
    • Current pregnancy details
    • Prenatal care information
    • Nutrition and exercise habits
    • Emotional well-being
  3. Birth Plan Worksheet:
    • Preferences for labor and delivery
    • Pain management preferences
    • Desired atmosphere in the birthing room
    • Postpartum wishes
  4. Emergency Contact Information:
    • Names and contact information for emergency contacts
  5. Doula Services Agreement:
    • Scope of services
    • Fee structure and payment schedule
    • Cancellation policy
  6. Photography/Videography Release Form:
    • Permission to take photos or videos during labor and birth
  7. Informed Consent Forms:
    • Acknowledgment of the doula's role
    • Understanding of the limitations of the doula's scope of practice
  8. Communication Preferences:
    • Preferred communication method (phone, email, text)
    • Availability and preferred times for check-ins
  9. Postpartum Support Plan:
    • Support needed during the postpartum period
    • Breastfeeding plans
    • Emotional well-being considerations

Remember to ensure that your forms comply with local laws and regulations regarding client information and privacy. It's also helpful to review and update your forms periodically to reflect any changes in your doula practice or to incorporate feedback from clients. Additionally, you may want to consult with a legal professional to ensure that your documents adequately protect both you and your clients.

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Bridgette McQueen Birth Doula from Franklinton, North Carolina

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