Tell us about yourself!
Thanks for your interest in our birth coaching services!  

Some of the questions in this form are a bit personal, so only fill out what you are comfortable answering, and know that we regard your information with the highest confidentiality.  We’ll do our best to connect you with a team member that best aligns with your expectations, needs, and budget.
We look forward to serving you!

If you have any questions, feel free to contact hello@expectingjoy.com or call 425.298.6448.
start
 
Mother's Full Name:

 
Support Persons Full Name:

(such as a husband or partner)
 
Expected Birth Date:

 
Home Address:

 
Mother's Phone Number:

 
Support Person's Phone Number:

 
Number of previous pregnancies:

 
Number of previous miscarriages:

 
Number of previous abortions:

 
Number of Premature Births:

babies born less than 36 weeks old
 
Number of Living Children:

 
Have you ever had a C-section?

     
 
If YES, what were the circumstances surrounding the decision to have a C-Section?

 
Have you ever had a VBAC?

(VBAC is a Vaginal Birth After Cesarean)
     
 
Who is your care provider?

indicate whether s/he is an OB, direct entry midwife, CNM, Family Practice MD, Other
 
Where do you plan to give birth to your baby?

Or where was your baby born?
 
Do you have any medical concerns we should be aware of?  
Is so, please share:

 
How are you feeling about labor and delivery?

What is your biggest fear about labor and delivery?
 
If you could labor and deliver your baby anywhere in the world, and not having to worry about your safety or that of your baby, where would your ideal birth take place?

Who would be with you, and what sights, sounds, and smells would be surrounding you?
 
When you are in pain, what types of personal comforts do you like to use?

examples: a quiet room, heat, cold, words spoken, etc.
 
Where do you hold tension in your body and what provides relief?

 
What questions do you have for myself, your provider, and one another?

 
What price range are you expecting to pay for a birth coaches' services?

Our team of birth coaches charge different price points, depending on experience and availability.  Your response here helps us match you with the best candidate for your budget.  We're pleased to accept FSA/HRA/HSAs.

 
[OPTIONAL] Is there a member of our team that you are interested in interviewing?

Meet our team at www.expectingjoy.com/our-team/

 
All of our new doulas undergo an apprenticeship with experienced doulas.  Would you be comfortable with a new doula accompanying an experienced doula in your birth for a discount on our services?

 
How did you hear about Expecting Joy?

 
What's your favorite hot beverage? :)

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