Sacred Mama Wellness Doula Consultation Request & Compatibility Questionnaire
Thank you for considering my holistic birth doula services, specializing in natural home births. To ensure that my approach aligns with your needs and preferences, please take a moment to complete the following questionnaire. Your responses will assist me in determining compatibility and save both of us valuable time in the consultation process.
Full Name
*
First Name
Last Name
Date of Birth
*
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Congratulations on new life ! How far along is your pregnancy ?
How did you hear about Sacred Mama Wellness?
In-person
Reffered to by a friend/family member
Social Media
Directory
Other
Select what services you are interested in
Birthing Doula
Postpartum Doula
Belly-Binding
Lactation guidance
Placenta Encapulation
Other
How would you describe your confidence level in your ability to birth naturally at home? (ex. high, low, in the middle)
Have you had any previous experiences or education that contribute to your confidence in natural birthing?
Where do you intend on giving birth?
Home
Birthing Center
Birth at home then hospital
Hospital
Unsure at this time
What factors are influencing your choice of birth location?
Do you intend on utilizing any drugs during birth? If so, what?
Epidural
Pitocin
Epidural and Pitocin
No, all natural birth, no drugs
Natural/herbal pain relief or none at all
No drugs, but open to natural holistic pain relief options
Epidural or Pitocin if emergency, if not, no drugs
How would you characterize your current lifestyle? (e.g., dietary choices, wellness practices, holistic approaches)
If you have a holistic lifestyle or approach, are there specific holistic practices or beliefs that are important to you in the context of childbirth?
If applicable, can you share any details about your previous birth experiences, whether at home or in a hospital setting?
What are your views on medical interventions during childbirth, and do you have any specific concerns or preferences?
Do you have at least one or two people to support you in your birthing process ?
To better align my services with your needs, what budget range do you find reasonable for investing in a doula ?
Describe the perfect doula for your birthing experience
In the event that we are not aligned, you will receive an email within 2-3 business days notifying you of this outcome. Conversely, if we are compatible, you will receive an email within the same timeframe, containing a link to schedule a consultation with me. During this consultation, we'll have the opportunity to delve deeper into your requirements and preferences, laying the foundation for our collaborative journey.
Thankyou for your time - Indigo (Sacred Mama Wellness).
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