SS Doula Care Intake Form

  • Birth Doula Client Intake Form

    Thank you for taking the time to complete this form. Your responses help us better understand your needs, preferences, concerns, and hopes so we can provide thoughtful, personalized support throughout your pregnancy, birth, and postpartum journey. At the heart of our work is a commitment to making you feel seen, supported, informed, and cared for every step of the way. Once your form is submitted, you’ll be automatically prompted to schedule a complimentary virtual consultation with our team. This gives us an opportunity to connect, learn more about your vision for support, answer any questions you may have, and ensure we’re the right fit for your journey. We’re truly honored to be considered as part of your birth and postpartum support team— We can’t wait to connect with you!
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  • Current Pregnancy Information

  • Estimate Due Date*
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  • Pregnancy History 

  • Have you given birth before?*

  • Offerings

    A $150 non-refundable retainer is required to secure your spot. Flexible payment plan options are available to fit your needs.

  • ✨ Standard Birth Support Package — $1500(In-Person) / $600(Virtual) || Travel and Out of state fees may vary


    Support curated for you every step of the way — from pregnancy, through birth, and beyond.

    Standard Birth Support Package Includes:

    • Birth Planning Session: Together, we’ll thoughtfully explore your vision, preferences, and goals for birth and the immediate postpartum period. This session includes in-depth discussion around labor support options, comfort and coping techniques, birth environment preferences, partner involvement, newborn care wishes, postpartum planning, and evidence-based education — helping you feel informed, confident, supported, and fully prepared for your birth experience.

    • Three General Prenatal Appointments:These personalized sessions are designed to support your physical, emotional, and educational preparation for birth. Appointments may include stress-reducing exercises, labor positioning, hip openers, guided breathing techniques, relaxation methods, gentle stretching, massage therapy to support the nervous system, nature walks, evidence-based education, and personalized guidance to help prepare your body and mind for labor.

    One of these visits is a dedicated 35–36 week final birth preparation session, focused specifically on preparing for labor, birth, and the immediate postpartum period. During this appointment, we’ll review comfort measures, coping techniques, partner support, birth preferences, signs of labor, positioning strategies, postpartum planning, and answer any final questions so you feel grounded, confident, and fully prepared as birth approaches.

    • 1:1 Childbirth Education Workshop: A personalized education and coaching session curated specifically for your unique pregnancy, birth goals, and concerns. This workshop may cover the stages of labor, comfort techniques, partner support, hospital or home birth preparation, postpartum recovery, newborn care basics, and evidence-based guidance to help you feel confident and supported throughout your journey.

    • Unlimited Communication During Business Hours (9AM–6PM)
    Call, text, or email with any updates, questions, or concerns. I want to hear it all — the more I know, the better I can support you!

    • 24/7 On-Call Support Starting at 35 weeks: You’ll receive a 35-Week Labor and Birth Prep Packet, and I’ll be on-call day and night once you're confirmed full term.

    • Unlimited Labor & Birth Support: From the time active labor begins through approximately one hour after birth, I will provide continuous, unwavering emotional, physical, and informational support tailored to your needs throughout the entire labor and birth experience. This includes hands-on comfort measures, breathing and relaxation guidance, labor positioning, encouragement, advocacy support, evidence-based information, support for your partner, and a calming presence to help you feel safe, empowered, and supported every step of the way.

    •Included Postpartum Visit: A check-in within 10 days of birth to assess recovery, offer resources, and adjust support based on your needs

    • 💻 Virtual Package – ($600)- Ideal for long-distance families seeking personalized guidance, education, and compassionate virtual support throughout pregnancy, labor, and the early postpartum period. This package is designed to help you feel informed, prepared, and confidently supported — no matter where you are located.

     

    🧑🏾‍🍼 Postpartum Support or pregnancy add ons – $30/hour
    Compassionate, holistic support designed to nurture you through pregnancy, postpartum recovery, and the transition into parenthood. Each visit is tailored to your unique physical, emotional, and household needs so you feel cared for, rested, and supported during this transformative season.

    Availability:
    • Daytime support available between 8AM–6PM
    • Minimum 4-hour shifts
    • Overnight newborn support available (typically 10PM–6AM)

    Support may include:
    • Newborn care and hands-on guidance
    • Emotional support and wellness check-ins
    • Postpartum recovery support following vaginal or cesarean birth
    • Sibling care or short-term nanny-style assistance
    • Light housekeeping (laundry, dishes, tidying, bottle washing, etc.)
    • Nourishing meal preparation or light cooking
    • Assistance with errands and daily tasks, as needed
    • Feeding support and newborn soothing techniques
    • Gentle encouragement, rest support, and transitional care for the whole family

    In-home wellness offerings: Thoughtfully curated wellness experiences to promote relaxation, nervous system support, and overall well-being during pregnancy and postpartum.
    • Luxurious At-Home Spa Facial
    • Relaxing Facial & Body Massage
    • Herbal Foot Soak Therapy
    • Restorative Vaginal Steam Session

    Educational Class – $75
    (2-Hour Virtual Session)

    A personalized, evidence-based education session designed to help you feel informed, confident, and prepared for pregnancy, birth, postpartum, and newborn care. Each class is tailored to your unique questions, goals, and desired areas of support.

    Perfect for individuals, couples, or growing families seeking guidance on topics such as:

    • Birth preparation and labor expectations
    • Postpartum planning and recovery
    • Lactation and infant feeding support
    • Comfort measures and pain management techniques
    • Partner support during labor and postpartum
    • Newborn care basics and soothing techniques
    • Creating a personalized birth plan
    • Hospital, birth center, or home birth preparation
    • And more, based on your specific needs and concerns!

    Ideal for those who want focused, personalized education and have specific questions.

  • Birth Preparation

  • What type of support are you looking for?
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