Welcome.

Thank you for choosing Morse Doula to support your birthing journey!

The below information will get us started. Please fill this out to the best of your knowledge but don’t worry if there are things you can’t answer or don’t know yet. We’ll talk about them all when we meet.

Birth Giver Name

First Name

Last Name

Partner's Name (if applicable)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Age

Due Date

YYYY

Place you are planning to give birth:

Have you or are you planning to take a Childbirth Preparation Class? If yes, which type and with whom?

Do you have any special needs during your pregnancy and/or birth? If so, what are they?

Do you have any illnesses that you anticipate will complicate your birth?

What do you anticipate will be your emotional needs during labor?

If this is not your first birth, please describe in detail your previous births. Please feel free to use a separate pi

How do you normally deal with uncomfortable/unknown situation?

How do you see yourself coping with the journey of labor?

As the birthing person, what physical preparations have you been doing to prepare your body for labor and birth?

Do you wish to avoid pain medication?

Do you have any cultural, religious, or spiritual needs that you would like to share with me?