Newborn Care Assessment
Congratulations on your baby! Please take some time to answer the questions below regarding your new baby and how we can support you.
Name
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First Name
Last Name
Spouse/Partner's Name
*
First Name
Last Name
Email
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example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about us?
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What is your estimated due date?
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Is this your first child?
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Yes
No, but we are looking for a different level of support this time.
Tell us a little about your pregnancy journey so far.
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What made you interested in concierge newborn care, and specifically the Natural Kid Doc approach?
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What are you most anxious, overwhelmed or uncertain about as you prepare for birth and the first year?
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What kind of support do you feel would help you feel calmer, more confident and better prepared as a new parent?
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When it comes to medical decisions for your baby, how would you describe your ideal relationship with your pediatric provider?
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Our concierge model is collaborative and discussion-based. How comfortable are you with shared decision-making, where we discuss options together and you choose what feels best for your baby and family?
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Very comfortable — this is exactly what I want
Mostly comfortable but I have questions
I prefer the provider to tell me exactly what to do
I prefer to do all my own research and make decisions independently
Do you value attending routine well-baby visits and proactive care in the first year?
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Yes, absolutely
Unsure
No
What does “a successful first year” look like for you and your baby?
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What would make you feel most supported by the end of the program?
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Are you open to learning new approaches, receiving guidance, and partnering together throughout your baby’s first year?
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Yes
Mostly
Not sure
This is a high-touch, high-access concierge membership designed for parents who want extensive 1:1 support and are ready to invest in a premium level of care. Which statement best reflects you?
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I am ready for a high level of support and understand concierge care is an investment in our family’s well-being.
I’m highly interested and just want to understand the full details before committing.
I am very cost-conscious and unsure if concierge-level care is right for us.
Is there anything else you’d like to share about your family, birth preferences, or what you’re hoping concierge care might help you with?
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Thank you for taking the time to fill out this form. We will contact you shortly to help determine the next best steps for your family.
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