Birth and Baby Services

Offering low-cost & no-cost birth doula services


Health & History Form

Thank you for taking the time to complete this form, doing so will allow us to understand how we can best support you. This form does not have a 'save' feature, so please complete this form when you have one-hour to complete.

A minor is age 17 and younger
Have you attended a childbirth class?*
How do you plan to feed your newborn?*
If you plan to breastfeed, have you attended a breastfeeding class?*
Smoking history of the birthing client*
Alcohol consumption of the birthing client*
Please check all that apply to the birthing client (past and present)*
Was this a planned pregnancy?*
please keep in mind that most hospitals limit the number of people in the birthing room to 4. Doula will be your doulas. Plus delivery is a very personal time and your birthing environment calm and as stress free as possible. Many of your guests can visit with you after your baby is born.
Birthing client, how does your body display tension? Please check all boxes that apply*
Birthing client, please share what type of birth you want*
I agree that if I get a restraining order against any person including the father of the baby, you will notify us right away. You also understand that BABS may not be able to support you if a restraining is in place.*
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Thank you for completing this form. We will be in touch soon to schedule our first meeting.