Estimated Due Date

YYYY

Name

First Name

Last Name

Phone

(###)

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Email Address

Your Partner's Name

First Name

Last Name

Your Partner's Phone

(###)

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What type of birth are you planning?

Address of Birth Location:

Care provider:

Name of Practice:

Phone Number of Practice:

(###)

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Who will be with you during this birth?

Partner

Midwife or OB

Doula(s)

Family

Friends

Other

Tell me about your birth plan

Have you had any complications during this pregnancy ?

Thinking about your birth photography, what images are the most important to you?

Are there any moments that you would be heartbroken if they are missed?

Is there anything that you do not wish to see in your birth photography?

How many pregnancies have you had, including this one?

Other:

How do you envision the environment during your labor and delivery?

Are you sensitive to any scents or noise? How do you prefer the lighting to be ? Are there any boundaries or preferences I should know about?

I am most interested in photos:

During my labor

Baby's Arrival

My new baby

I'd really just like a bit of everything!

Transfer

If for any reason you are to be transferred from home to hospital or from one hospital to another for any reason, would you want me to:

Social Media: I would love the opportunity to share your (non-revealing) birth images in my portfolio and with my followers. But, ultimately, The decision is up to you.

Would you like me to post a birth announcement and/or birth story blog post about your birth experience? A birth announcement or blog post would be published after YOU have announced the birth on your own FB pages.

Are you comfortable with me posting non-identifying social media updates about your labor & delivery experience?

Do you want to be tagged in images on social media?

Is there anything else you feel you should share with me?