JESSICA KETTLE PHOTOGRAPHY - BIRTH STORY QUESTIONNAIRE

Jessica Kettle Photography - Birth Story Questionnaire
Name:

First NameLast Name
Primary Phone Number

Area CodePhone Number
Secondary Phone (support person)

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail:
Delivery Location:
Due Date:
Who will be delivering your baby?
Doctor or Midwife's name:
Office or Practice name:
Main Support Person and Relationship(i.e. spouse or parter):
Other Support People/ Relationship who will be present:
Are there children or other family members who will be coming after the birth who you want photos with?
General Birth Plan:
Are you planning to go into labor naturally or is induction a possibility?
Induction Date, if applicable:
Do you anticipate delivering before or after your due date for any reason? If so, explain.
How many prior delveries have you had?
Notable Prior Birth history I should be aware of (i.e. fast or slow labor, early or late delivery etc.)?
Any Special Photo Requests or Details you would like me to pay special attention to?
Are there any concerns you have about your birth story or delivery?
Are you comfortable with me sharing your photos on my blog or business page?

YesNoOnly after approval
Would you like a facebook sneak peek (don't worry, something modest of the baby or you and the baby!)?

YesNo
Should be Empty:

Jessica Kettle Photography - Birth Story Questionnaire