birth story booking form

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Name(required)

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Email(required)

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Estimated Due Date (YYYY-MM-DD)

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Phone

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What city are you located in?

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Partner’s Name

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Partner’s Phone Number

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Location Type

Hospital

Birth Center

Home

Other

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Location Address

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Care Provider

Doctor

Midwife

Unassisted

Other

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Name of Practice

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Practice’s Phone Number

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People In Attendance —
check all that apply

Partner Midwife Grandparent(s) Doula Sibling(s) Friend(s) Videographer Other

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Others — please explain

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Current Pregnancy —
How is it progressing? Check any that apply.

Normal with no complications High risk Preterm labor / dilation Some complications, but no concern as of now

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Transfer —
If for any reason you are to be transferred from home to hospital or from one hospital to another for any reason, would you want me to:

Wait for instructions

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What I would like photographed —
Check any that apply.

Labor Family in attendance Care Providers – with permission Nudity ok Nudity not ok Crowning shot Side shot during delivery Over the shoulder during delivery Nursing First bath Weight/Height Foot Prints Family with baby Images with care provider and/or nurses

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Others — please explain

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I want most of my pictures to be of:

My labor experience (my team helping, different positions I try, the overall scene throughout my laboring)

The moment the baby comes (everyone's reactions, the baby!)

My sweet, new baby (at arrival, but also perhaps a small photo session a little while later)

I'd really just like a good mix of everything!

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Any additional comments ?

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