CLIENT INFO QUESTIONNAIRE | The Homegrown Doula

Doula basket filled with handmade food surrounding my fresh produce in the garden

Client Questionnaire

If you could please fill out my client questionnaire, this help to capture some essential info and get your mind thinking about a few things too. It might be best to jump on a desktop/laptop, to save your thumbs!

Full Name

Phone number:

Personal background:

Can you please tell me a little bit about your family and a bit about yourself and your partner?

Have you had any previous experiences with pregnancy, childbirth, or parenting?

Pregnancy and Birth Preferences:

What kind of support are you looking for from a doula?

How would you like me to communicate and collaborate with your healthcare provider or birth team?

Are there any speciﬁc concerns or challenges you anticipate during your pregnancy or birth?

Previous Birth Experiences:

If applicable, can you share any previous birth experiences you've had? Is there anything you would like to approach differently this time?

What were the aspects of your previous birth experiences that you found most challenging or rewarding?

Expectations and Availability:

What are your expectations regarding my availability before, during, and after the birth?

Are there any speciﬁc cultural or religious practices that you would like to incorporate into your birth experience?

Partner or Support Person:

How do you envision your partner or support person's role during the birth? How can I support them?

Are there any concerns or considerations related to involving your partner or support person?

Postpartum Support:

What are your expectations or preferences for postpartum care?

Practical Considerations:

What is your estimated due date?

What is your home address?

Have you selected a birthplace or healthcare provider for your pregnancy and birth?

Is there any additional information or speciﬁc questions you would like to discuss during our meeting?

Thanks for submitting!

Tell me about you!

If I haven’t already, here is a questionnaire for your food/ flavour preferences that I’d love for you to complete, to help support me with cooking for you.

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