Birth Preparation – Form

Time to Share Some Info With Me!

Now that you have read the education document it’s time to fill in your booking in form so that i have as much information as possible about you and where you are emotionally, physically and spiritually. If you’re unsure of the answer, don’t worry as we will discuss these parts in our zoom call – this is just giving me a basis to meet you where you are right now so that i can help you fill in the blanks.

Full Name

Phone number

Email Address

Due Date (in weeks)

Health issues

Pregnancy Issues

Type of Conception (natural or assisted - ivf, iui, egg donor)

Is this your first birth?

If not, tell me about your previous births

Mental Health Issues

How are you feeling emotionally about birth?

What fears do you carry ahead of birth if any?

If you could pick your ideal birth, how would it look and feel?

What might stop you having this ideal birth?

Do you believe in your body's ability to birth?

What is your mums attitude to birth?

Describe your own birth

What fears does your partner carry ahead of birth?

Partners feelings ahead of birth?

Have you had any operations or bad falls?

Suffered any issues with your yoni?

How was your first period met was it celebrated or shamed?

Have you suffered any sexual or abuse issues?

Anything else i need to know ahead of your birth about your emotional, physical and spiritual self?

7 + 9 =

Book Call