birth story booking form

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Thank you for your response. ✨

Name(required)

Email(required)

Estimated Due Date (YYYY-MM-DD)

Phone

What city are you located in?

Partner’s Name

Partner’s Phone Number

Location Type

Hospital

Birth Center

Home

Other

Location Address

Care Provider

Doctor

Midwife

Unassisted

Other

Name of Practice

Practice’s Phone Number

People In Attendance —
check all that apply

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

Others — please explain

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

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

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

Others — please explain

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!

Any additional comments ?

Thank you for your response. ✨

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