Client Information
First Name
Last Name
Address
Client Phone
Client Email
Mom Workplace
Birth Information
Due Date (mm/dd/yyyy)
# of Birth(s)
Birth Location
OB/Midwife
Important Info
Birth Plan (If you have one typed out, Copy and Paste here)
People Attending Birth
Epidural
Aromatherapy
Massage
Food Allergies or Triggers
Tub
Pictures-Video
Delayed Cord Clamping
Immediate skin to skin
Baby bath
Envisioned birthing position
Favorite affirmations
GBS+?
Labor at studio?
Why are you choosing this birth
Baby Name
Partner Information
Partner Name
Relationship
Partner Phone
Partner Email
Partner Workplace
Referred by