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Client Intake

All birth and postpartum doula clients should complete the following form. This will provide the information necessary to start working effectively with your doula.

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Name
Please provide the best number to reach you.
This will be where most of our in-person meetings take place unless you specify other arrangements or opt for virtual meetings.
Relation examples: spouse, husband, wife, fiancé/fiancée, boyfriend/girlfriend, domestic partner, co-parent, your parent, sibling, friend, etc.
This is completely up to you and not limited to the terms suggested. Please feel free to share whatever term(s) your family wishes to have used.
Have you participated in any childbirth classes, or do you plan to?
Please provide the name of the hospital or birthing center, or write “home” if planning a homebirth.
Previous births/deliveries
Please check all that apply.
Location/attendants for previous births/deliveries
Please check all that apply.
For postpartum doula clients, are there any areas of support you feel are most needed?
Please check all that apply.
If only using other forms of consumption (e.g., dip, snuff etc.), answer No.
If only using other forms of consumption (e.g., edibles, tinctures, etc.), answer No.
Is there any area of your life in which you feel unsafe or need support?
Please check all that apply.
Interested in receiving information about upcoming events and other products/services offered by Atala Doula Services?
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