Client Birth Questionnaire

Estimated Due Date:


Tell Me About Yourself

Your Name

Your Phone

Email Address

Partner's Name

Partner's Phone

Address


Tell Me about your Birth (Upcoming and/or Past Births)

Current Birth Plan

Location type:

Location Address:

Is the birthing facility okay with a photographer being present?

People in attendance:

List any people that will be attending the birth of your baby. Check any that apply.

Others - please explain:

Current Pregnancy:

How is it progressing? Check any that apply.

Past Labors:

If this is not your first labor, can you please describe how your past labor/deliveries have gone? Check all that apply.

Other - please explain:

Do you know the gender of your baby?

Hospital Transfer

In the event of you or baby needing to be transferred to another facility for whatever reasons


Let's talk about pictures during your labor & delivery

What I would like photographed:

Other - please explain:


Social Media

As you probably know, social media is my largest tool for sharing my work and celebrating clients. I would love the opportunity to share your (non revealing and most modest) birth images in my portfolio and with my followers. But, ultimately, the decision is up to you.

Would you like me to post a birth announcement and/or birth story blog post about your birth experience?

Are you comfortable with me posting non-identifying social media updates about your labor & deliver experience?

Do you want to be tagged in images on social media?


Any additional comments or information?

Please fill out as much information as you can. We may have already discussed some of the details but this will help to keep everything organized specific to you and your session with me. If there is more information you’d like to provide me with or if you have additional questions, please feel free to use the “Additional comments or information” section at the bottom.
I will keep an eye out for a response and get back to you as soon as I can with any questions.

Thank you!
Amanda