Birth Plan info

Birth Plan info

This form will help me determine a few things prior to our virtual meeting...you can't give me too much info so type all you want!!
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
How many pregnancies (G) how many births (P) ex: If this is your 3rd pregnancy but you have only birthed one baby then that looks like this G3P1
Previous birth experience (vaginal, c-section, long labor, long pushing phase, breech, forceps, vacuum, pre-term labor, epidural, nitrous, etc...)
What are the TOP 10 things you want during this delivery? Please list in order of importance
How have you prepared for this delivery? birthing class, reading, research, etc
Have you discussed your desires (Top 10) with your provider?

yesno (please do so before we meet)
Who will be your support person(s)? Please have them attend our consultation
Please name 5 things you ABSOUTELY do not want to happen at your birth (ex lights on, epidural, confined to bed, formula, pitocin, etc) please keep in mind some things aren't controllable but there are things that we can try to prevent them from happening
List your biggest fears....as many as you would like
After I read through your birth plan questionaire, expect an email from me at bbywhisperer@gmail.com within 72 hours to follow up with some more information that will include scheduing a consult and a booking link. I would like your support person to attend the consult if possible so we can work out times that fit your needs. Your final birth plan will be sent to you as a PDF for you to print and it will be personalized with everything we discussed.
Please give me some days (Monday-Friday) and times that work well for you and include your time zone
prevnext( X )
30 Minute ConsultationEnter description
$30.00 Quantity

Total

$0.00
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