Savvy Doula Client Intake Forms
Birth doulas may find it helpful to have their client complete an intake form and/or a questionnaire before meeting with them for the first time. Intake forms and questionnaires help mom and the birth partner get clear on what they want for their births, and it gives valuable information to the birth doula. Birth doulas can learn more about their client’s preferences in terms of the kind of birth they want and the kind of support they desire from their doula. It also serves as a way to guide prenatal visits by helping to create a dialogue, not only between doula and clients, but between moms and their birth partners.
Forms are sold individually so that the you can choose exactly what you need, or you can purchase the entire set of six forms. These forms are in Microsoft Word format so that you can customize them to better suit you and your practice. Following confirmation of your purchase, you will receive an email that will include links to download your forms immediately.
Here is what you will find below:
- Client Intake Form – Collects basic information. Choose from one that can be printed and completed, or one that can be easily emailed and completed in Word by your client.
- Prenatal Support Intake Form – Detailed Questionnaire to be completed by Mom
- “How Can I Best Support You?” – Checklist that Mom can complete that informs doula her desires during labor and birth
- “What Is Most Important To You To Have During Your Labor And Birth” – Mom ranks desires on a 1-5 scale of Importance on a variety of choices, to help her doula tap into Mom’s values and preferences
- “How Can Your Partner Best Support You During Labor?” – This questionnaire helps empower the Birth Partner to discover ways he can support Mom
For the best value, a complete set of all the Savvy Doula Client Intake Forms are available at the bottom of this page.
All forms come with a 30-day money back guarantee. If you are unhappy with any form you purchase, contact me for a full refund.
Client Intake Form for Birth Doulas – Printable
One of the first things you will need from a new client is a completed profile of basic information. This 3-page document will collect basic contact information and also ask for information related to your client’s care during this pregnancy. You can also gather information about classes your client has taken and basic preferences for labor, birth and postpartum.
This intake form is a Microsoft Word document and can be customized by you to meet your specific needs.
Client Intake Form for Birth Doulas – Unlined for E-mail
This is the same form as the printable one, but it does not have any lines for writing on. This client intake form is convenient for emailing to clients so they can complete it in MS Word, then e-mail it back to you, or print it and give it to you at their first prenatal visit.
“How Can I Best Support You” Questionnaire
This one-page questionnaire asks mom to read a list of ways you can support her during labor and birth and check what is interesting to her. At the bottom of the page, she can list additional ways she likes to relax. The items listed are mainly a variety of specific comfort measures. This form is a Microsoft Word document and can be customized by you to meet your specific needs.
“What Is Important For You To Have” Questionnaire
This one-page questionnaire asks mom to read a list of ways you can support her during labor and birth and rank each one on a 1-5 scale, where 1 is “Unimportant” and 5 is “Very Important”. At the bottom of the page, she can list additional points. The items listed are address her emotional needs. This form is a Microsoft Word document and can be customized by you to meet your specific needs.
“How Can Your Partner Best Support You” Questionnaire
Mom is instructed to give this form to her birth partner to complete. Birth Partners often feel unsure about how they can help mom during labor. This questionnaire offers birth partners a starting a point for conversations with mom, where they can discuss ways that mom is comforted in every day life by her partner. This often lets birth partners see that they will be very capable of emotionally supporting mom during labor and birth, which can be a great confidence booster for both mom and partner. This form is a one-page Microsoft Word document and can be customized by you to meet your specific needs.
Prenatal Support Intake Form
This is a comprehensive 4-page intake form that asks mom to reflect on her pregnancy, share some history about herself that could impact labor and birth, disclose any concerns or fears, and answer other questions that can help her birth doula further understand her client’s needs. Birth doulas may not want to ask all the questions that are included on this form or may want to add other questions, so this Microsoft Word document is easily customizable to suit your specific needs.
Savvy Doula Client Intake Forms – Complete Set
Save by purchasing the complete set of all the above forms.
Have you seen:
- Initial Phone Consultation Form for Birth Doulas
- Previous Birth Experience Questionnaire
- Doula Client Services Checklist
- Client Loan Form
- Summary of Labor and Birth
- Prenatal Appointment Log
- Labor and Birth Log
- Postpartum Appointment Log
- Phone Log
- Appointment and Phone Log
More forms and products will be added soon. Be sure to subscribe to the Inspired Birth Pro newsletter to be the first to receive updates on new offerings.
If there is a particular form you are looking for and are unable to find elsewhere, contact me, and I’ll see what I can do to help.