Hello and Welcome!

What a joy it is to witness, celebrate, and support you as you prepare for the birth of your child! This is an important and magical time of transition in your life, and I am deeply honored to help you navigate your journey to parenthood.

I ask that you complete this intake form at least 24 hours ahead of our first meeting to ensure that our in-person time together is as rich and fulfilling for you as possible. I provide individualized coaching and support, so our session(s) together will be customized to reflect your particular interests and needs. Please set aside enough time to be fully present and thoughtful in your answers.

If partnered, I encourage you to fill out this form together, noting places where you and your partner are in strong agreement, as well as places where your beliefs or understandings about birth or parenting differ. Where appropriate, feel free to enter two answers in a comment box, one for each of you. My intention for our work together is to consciously craft a vision and plan for your birth and parenting that honors you both as individuals, while taking your relationship together higher.

Childbirth is a time when old hurts can rise up in new ways. Please know that I am here if you ever want to process old emotional or physical abuse or trauma that you feel might be triggered by birth or parenting. Let this be a time to release and heal old stories, rather than confirm and reinforce them. There are no right or wrong answers, only what is right and true for you. Anything that you share with me will be held with care in complete confidentiality.

I look forward to connecting soon.

Love always and in all ways,


NOTE: I recommend that you type your answers to these questions in a separate document so that you can save as you go and have a copy for your records, then copy and paste your answers into this form.

Birthing Parent's Name *
Birthing Parent's Name
Your Birth Date *
Your Birth Date
Phone *
Partner's Birth Date
Partner's Birth Date
Partner's Address
Partner's Address
Partner's Phone
Partner's Phone
On a scale of 1-5, how informed do you feel you are about childbirth?
Are you taking/interested in taking a childbirth education class?
Which of these two statements better reflects your beliefs about birth:
Would you say that you and your partner are in agreement about your birth choices? Do you share similar beliefs and desires?
Do you feel well supported in your birth choices by your partner, family, friends, healthcare providers, etc.?
Have you thought about hiring a doula?
On a scale of 1 to 5, how prepared do you feel you are to handle and care for a newborn?