Labor Support Form - Doulas Milwaukee

"*" indicates required fields

Pregnant Person's Name*

First Last

Phone*

Email*

Non-Pregnant Partner's Name

if applicable

First Last

Partner's Phone

Partner's Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

What is parking like around your home?*

Please select all that are within a 2-block area around your home.

Free street parking

Permit parking - client to provide permit

Metered parking

Garage - free

Garage - paid

Driveway

Do you have any pets in your home?*

If yes, please include what type of animal/s and their name/s.

Expected Due Date*

Expected Birth Location*

Name of hospital, birth center or homebirth

Name of Doctor/Midwife*

How do you feel a doula can support you? What are you looking for in a doula?*

There are many established benefits to having labor support. Please share with us what is drawing you to exploring doula support.

What, if any, preferences or priorities may be forming for you around your birth experience?*

Are your wishes in line with your partner?

Childbirth & Parenting Preparations*

Have you taken or plan to take any classes on childbirth, parenting, breastfeeding, newborn care, etc? Are you reading any books on birth and/or parenting?

Health & Wellness*

Please share anything you would like to about your health history that will assist us in matching you with a doula. Please also include anything about your current fitness/movement: prenatal exercise, yoga, meditation/mindfulness, walking, swimming, etc.

Any cultural or family traditions you would like us to be aware of when matching you with a doula?*

I am interested in:*

Traditional Package including in-person support

All-Virtual Package

I'm not sure and want to discuss

Is there anything else you can share about yourself and about your partner that would help us to make a great match?*

Please share anything here that would impact the matchmaking process.

How did you hear about us?*

Please specify the name of who referred you*

If not applicable, type N/A

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