Full Name

Phone Number

Email Address

Spouse/Partner Name

Due Date

Location of Delivery (Hospital, birth center or home address)

Midwife or Doctor name

Do you have a birth plan?
YesNo

Will you have a doula?
YesNo

If yes, what is their name & phone number (if you have it available)?

What images are most important to you?

Do you want crowning images? (these images will NOT be shared without your written consent. You always have the option to delete them later if you decided you don't want them)
YesNoNot Sure

Are you interested in the following?

A highlight album of your birth images
YesNoNot Sure
Prints
YesNoNot Sure
Digital images only
YesNoNot Sure
Other
YesNoNot Sure

Any complications during pregnancy? If yes, please explain

Any specific practices that will be performed (delayed cord clamping, skin to skin, etc.)?

Any other comments or considerations you'd like to share?