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Doula Intake Form
Your Name
Doctor/Midwife’s Names
Email
Phone
Baby’s Gender and estimated due date.
Explain any complication you may have had with this pregnancy, any restrictions your caregiver has given you, and any medications you are currently taking.
Have you taken or are You planning on taking any childbirth education classes? If so, what are they and where are you attending them?
Do you have a birth vision planned?
Explain any complication you may have had with your other pregnancy & labor?
How do you feel about interventions in labor/delivery?
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