Postnatal doula client questionnaire Name * First Name Last Name Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country What is your preferred contact method? e.g. calls, WhatsApp, email Emergency contact Name, relationship to you & phone number (###) ### #### Are there any medical conditions or concerns I need to be aware of during postnatal care? Are there any specific healthcare providers you'd like me to co-ordinate with? e.g. lactation consultants, midwives etc How would you like me to enter the house? e.g. let myself in via a lockbox, shoes off outside etc Is there anything in your home I need to be aware of? e.g. steep stairs, any quirks Are there any cultural or personal preferences you'd like me to be aware of? Are there any specific parenting philosophies or approaches you resonate with that you'd like me to follow? e.g. Gentle Parenting Are there any postnatal rituals or practices you'll be following that you'd like me to note? Do you/your family have any specific dietary requirements, preferences or needs? e.g. allergies, sensitivities, free-from Is there anything you'd like me to consider when communicating with other family members? e.g. your other children, grandparents, partner Would you like to discuss your birth experience or any feelings surrounding it during our visits? Are there any particular feeding methods you've considered, and how can I support your choice? Do you have any pets? Are there any special considerations I need to be aware of? Is there any specific support you're hoping to receive? Anything else you'd like to share with me? Thank you!
