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Client's Age
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How many pregnancies (including this one) have you had?
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How many children do you have (including this baby)?
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Client's Partner or Birth Companion's Name (if applicable)
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Age
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Relationship to Client
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When are you expecting your baby?
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Who is your care provider (doctor, midwife, group)
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Where are you planning to give birth?
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What are you most concerned about in this pregnancy, birth, & parenting?
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Home
About Me
Doula Services
Classes
Other Services
Register/Hire Me
Hire me as your doula
Register for a Class
OTHER SERVICES CLIENT INFORMATION FORM
Contact Me