authentic photos for authentic people
Home
About
Lifestyle
Interior
Brands
Gift a Session
Book A Session
Family Portraits
School Portraits
Mini Session
Blog
Connect
authentic photos for authentic people
Home
About
Lifestyle
Interior
Brands
Gift a Session
Book A Session
Family Portraits
School Portraits
Mini Session
Blog
Connect
Birth Questionairre
Let's Talk About You:
Due Date
*
MM
DD
YYYY
Mother's Name
*
First Name
Last Name
Mother's Number
*
Father's Name
*
First Name
Last Name
Father's Number
*
Tell me about your birth / (Upcoming or Past births)
Birth Plan:
*
Spontaneous labor
Induction
C-Section
Location Type:
*
Hospital
Home Birth
Birth Center
Other
Location Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Care Provider:
*
Midwife
Unassisted
Other
Name of Practice:
*
Phone Number of Practice:
*
People in Attendance:
*
List any people that will be attending the birth of your baby. Check any that apply.
Partner
Grandparents
Doula
Sibling
Friend
Midwife
Other
Others, please explain:
*
Current Pregnancy
*
How is it progressing?
Normal with no complications
High Risk
Preterm labor/dilation
Some complications, but no concern as of now
Past Labor(s):
*
If this is not your first labor, can you please describe how you past labor/deliveries have gone? Check any that apply.
Preterm Labor
Within 1 week of EDD
1+ week past EDD
Within a few days of EDD
Quick
Even pace
Slow
Natural
Induction
Scheduled C-section
Emergency C-section
Preterm Baby
Mom interventions
Baby interventions
This is my first labor
Please give me a short synopsis of your past labor experience:
*
Do you know the gender of your baby?
*
Yes, girl
Yes, boy
No, we haven't found out yet
No, we are waiting until the baby is born to find out
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:
Follow
Wait for Instruction
LET'S TALK ABOUT PICTURES DURING YOUR LABOR & DELIVERY
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
Other - please explain:
Social Media
AS YOU PROBABLY KNOW, SOCIAL MEDIA IS MY LARGEST TOOL FOR SHARING MY WORK. I WOULD LOVE THE OPPORTUNITY TO SHARE YOUR (NON-REVEALING) 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?
*
A birth announcement would be posted on Facebook within 48 hours of your birth experience. A blog post would likely be published within a few weeks.
Yes, we would love that!
We would like to be the first to announce our news on social media, but you can post an announcement and blog post after we share our news.
No, thank you. We don't plan to share much over the internet.
Are you comfortable with me posting non-identifying social media updates about your labor & delivery experience? *
*
Sure
It's okay as long as you are very subtle
Please don't post anything
Any Additional Comments/Information?
Thank you!
