Estimated Due Date: *

MM

DD

YYYY

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Alternate Phone Number

(###)

###

####

Labor Partner's Name

First Name

Last Name

Partner's Phone Number

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Location Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number of Practice:

(###)

###

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People in Attendance: *

Please list any that may be attending the birth of your baby. Check all that apply.

Partner

Midwife

Grandparent(s)

Doula(s)

Sibling(s)

Friend(s)

Current pregnancy

How is it progressing? Please check all that apply.

Normal with no complications

High risk

Preterm labor/dilation

Some complications, but no concern as of now

Past labors *

If this is not your first delivery, please explain how your past labors have gone. Check all that apply.

This is my first delivery

Preterm labor

Within one to two weeks 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

Do you know the gender of your baby? *

Yes, boy

Yes, girl

No, we haven't found out yet but plan to

No, we want it to be a surprise

What I would like photographed:

Check all 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

Footprints

Family with baby

Images with care provider and/or nurses

I want most of my pictures to be of:

My labor experience (my team helping, different positions I try, the overall scene throughout my laboring)

The moment the baby comes (everyone's reactions, the baby!)

My sweet, new baby (at arrival, but also perhaps a small photo session a little while later)

I'd really just like a good mix of everything!

Transfer:

If for any reason, you would need to be transferred from home to hospital or from one facility to another, would you want your photographers to:

Follow

Wait for instruction

Would you like us 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 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.

Do you want to be tagged in images on social media?

Yes, please!

No thanks, I'll tag myself if I want to.

How did you hear about us? *

If a friend or provider referred you to us, please let us know who to thank in the space provided!

Google search

From a friend

From a provider

Other (please indicate below)

Checkbox 10

Option One

Option Two

Estimated Due Date: *

MM

DD

YYYY

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Who will be photographed? *

Please list anybody that might be in attendance when we come to your home after your baby is born.

Partner

Sibling(s)

Grandparent(s)

Midwife

Doula(s)

Friend(s)

Do you know the gender of your baby? *

Yes, boy

Yes, girl

No, we haven't found out yet but plan to

No, we want it to be a surprise

What I would like photographed: *

Check all that apply.

Breastfeeding

Family with baby

Images with midwife/in home visit

First bath

Herbal or milk bath

Would you like us 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 us coming to your home. 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 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.

Do you want to be tagged in images on social media? *

Yes, please!

No thanks. I'll tag myself if I want to.