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Doula Intake Form

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You help expectant families navigate their pregnancy, birth, and postpartum journeys, giving them the support they need. You take pride in offering personalized care, tailoring your services to each individual family's needs and desires.

But before you can start offering support, it's important to gather some information about your clients. That's where a doula client intake form comes in handy.

Creating a thorough and well-thought-out intake form helps you gather important information about your clients, including their medical history, birth preferences, and contact information. It also helps establish a level of trust and understanding with your clients before even meeting them in person.

Note: if you want to create a free doula intake form, try Bonsai. When you test-drive Bonsai, you'll get access to all of our invoice, contract, and proposal templates as well. Claim your 14-day free trial today.

Steps to follow when creating your doula intake form

First, consider the information that you need in order to provide personalized care for your clients. This can include medical history, contact information for their healthcare provider and support person, birth preferences, and any special considerations or requests.

Next, consider the best way to gather this information. Would a multiple-choice question work better, or would an open-ended question allow for more thorough responses?

Make sure your questions are clear, non-judgmental, and respectful of each family's unique situation.

For example, instead of asking "Do you plan on getting an epidural?" try "What are your thoughts/plans around pain management during labor?" This allows the client to answer honestly and openly without feeling pressured or judged.

Also, consider including a section for clients to provide any additional information or concerns they may have. This section allows your clients to list any preferred coping techniques or comfort measures, as well as any triggers or boundaries they may have. 

What information should you include?

In addition to the information mentioned above, some other important details to collect include your client's preferred method of communication, emergency contact information, and insurance information if applicable.

Another important aspect to consider is payment and cancellation policies. Make sure your clients are aware of any fees, refund policies, and cancellation procedures.

Example questions to include in your postpartum doula intake form

  • Do you have any concerns over your upcoming postpartum period?
  • What are your plans for postpartum support (i.e. visiting family members, postpartum doula, etc.)?
  • Do you have any allergies or medical conditions that we should be aware of during labor and delivery?
  • Do you have a preferred method of communication (phone, text, email)?
  • What common medical procedures would you prefer during early labor?
  • What are some of the newborn procedures and/or screenings that you do or do not want for your baby?
  • Are there any cultural or religious considerations we should be aware of during pregnancy, labor, and postpartum?
  • What is your birth vision? 
  • Do you have any triggers or boundaries that we should be aware of during prenatal meetings and the birth itself?
  • What are your plans for pain management during labor?
  • Are there any specific coping techniques or comfort measures that you prefer during labor?
  • What are your thoughts/plans around birth positions/labor positions and movement during labor?
  • Do you have a support person or birth team present during labor and birth? If so, who are they and what is their contact information

Download our free doula intake form template

A doula intake form is a great way to get to know your clients and their needs. It helps you understand their birth preferences and what kind of support they are looking for. By having this information upfront, you can be sure that you are providing the best possible care for your clients.

The doula intake form should include questions about the client’s previous births, their preferences for this birth, and any medical concerns that they have. This information will help you tailor your care to meet the specific needs of your client.

Creating and utilizing a thorough and well-thought-out client intake form is an essential part of providing personalized and respectful doula care. If you're looking for a starting point, consider downloading our free template. Our template will help you streamline your intake process and collect important information from your clients, setting the foundation for a successful doula-client relationship.

Doula Intake Form

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