First & Last Name

Phone Number

Email

Partner Name

Partner Phone Number

Estimated Due Date

Please specify any laboring techniques you will possibly use (Hypnobabies, Bradley Method, etc.)

Type of birth planned - home birth (with midwife) - home birth (unassisted) - birth center birth - hospital birth (labor will start naturally) - hospital birth (induction) - hospital birth (c-section)

Any specific practices that will be performed? (delayed cord clamping, cord burning, etc.)

What are the most important images to you?

Any complications this pregnancy? (If yes, please explain)

If home or birth center birthing, what hospital will you use in case of transfer?

For home birth and birth center births, in the event you are transferred, do you want me to follow you to the hospital, or go home and wait for instruction?

Plans for your birth photographs?- Share online with family and friends- Album- Prints- Large prints and/orcanvas- Archiving digital files- Other

What helped you make the decision to hire me over the other birth photographers in the area?

Facebook sneak peak?Yes No Yes, but after we see the images first

If you have a copy of your birth plan, please paste it below. This will bring me up to speed with your birthing team, plans for your birth, and guidance for your overall experience.

Is there anything else you'd like to share?