Initial consultation form

Inital Consultation Information

Thank you so much for your interest in my doula support! Please fill out this form in order for me to get to know you and maximize our initial consultation time. I will be in touch soon after this is submitted to schedule a video call consultation with you and your birth companion!
All the best,

Cortney, CD(DONA), HBCE

13andfinn@gmail.com

Your Name*

First NameLast NameHow should I refer to you? Ex: she/ her, mom, birthing person, gestational carrier, etc.

Birth Companion’s Name (if applicable)

First NameLast Name How should I refer to them? Ex: he/him, she/ her, boyfriend, husband, girlfriend, etc.

Address (used for in home prenatal visits)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

E-mail*

example@example.com

What is your estimated due date? *

Where do you plan to birth and who is your provider:*

Tell me a little about your pregnancy so far: *

Ex: first pregnancy, high risk, past experiences, etc.

Preferred day/time available for a virtual consultation (select all that apply)*

Weekday eveningWeekend morningWeekend afternoonWeekend evening

Are you interested in photography in addition to doula support? (If so, check all that apply)

Birth photographyFresh 48Birth photography & fresh 48

Have you ever taken childbirth education classes? If so, where/ what type? (Note: out-of-hosptial childbirth education is required for 13 & Finn clients)

How did you hear about us?

CLIENT details: