new client birth questionnaire

Estimated Due Date
Estimated Due Date
tell me about you
Name *
Name
Phone *
Phone
Alternate phone
Alternate phone
Partner's name
Partner's name
Partner's phone *
Partner's phone
Address *
Address
TELL ME ABOUT YOUR BIRTH (UPCOMING AND/OR PAST BIRTHS)
Location address *
Location address
phone of practice
phone of practice
People in attendance *
List any people that will be attending the birth of your baby. Check any that apply.
Current pregnancy *
How is it progressing?
Past labors *
If this is not your first labor, can you please describe how you past labor/deliveries have gone? Check any that apply.
Let's talk about your labor and delivery photos!
Do you know the gender of your baby? *
Transfer *
If for any reason you are to be transferred from home to hospital or from one hospital to another for any reason, would you want me to:
What I would like photographed: *
check any that apply.
Please be as specific as possible.
(e.g. epidural, emergency situations, internal exams, etc)
Please email me photos that illustrate both what you want and *don't* want: *
I would like most images to be: *
Social media
AS YOU PROBABLY REALIZE, SOCIAL MEDIA IS ONE MY LARGEST TOOLS FOR SHARING MY WORK. I WOULD LOVE THE OPPORTUNITY TO SHARE ONLY YOUR NON-REVEALING BIRTH IMAGES IN MY PORTFOLIO AND WITH MY FOLLOWERS. ULTIMATELY, THE DECISION IS UP TO YOU AS PRIVACY COMES FIRST.
Would you like me to post a birth announcement and/or birth story blog post about your birth experience? *
birth announcements are to be posted on Facebook within 48 hours of your birth experience. A blog post would likely be published within a few weeks.
Social Media "tagging" *
Are you comfortable with non-identifying social media posts about your labor and delivery experience?
Do you want to be tagged in images on social media? *
If for any reason I am not able to attend the birth, would you like me to request a back-up photographer? *
I understand that there situations beyond the control of StoryLight Studio that may make you unable to attend my birth:
(illness, acts of god, weather, etc)
I understand that if you are unable to make it, I am entitled to a complimentary family session: *
(e.g. fresh 48, newborn, and lifestyle session)