Two women sitting on a deck, surrounded by plants, talking and enjoying a scenic forest view.

book your free call

It’s important for us to get to know each other before deciding to move forward in working together. Therefore to book any of my doula packages the first step is to book your free 30min connection call. From there I can better understand your needs and we can see if you feel this will be the most supportive fit for you.

book your 30min call

Below is a guide for me to begin to get to know you deeper and how I can best support you. Please be as honest and transparent as you can, and please know that everything shared is highly confidential and not shared outside of our space together without permission.
Thank you so much for your time in completing this intake form before our first meeting.

Work with me Form 2

Name

First Name

Last Name

Preferred name

Date of Birth

MM

DD

YYYY

Phone number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Partner's name (if applicable)

How far along are you in your pregnancy journey? How many weeks and what is your estimated due date?

What stage or stages of support and offerings are you interested in from Nic?

What type of birth are you planning and where? What kind of support are you wanting/planning in the birth or postpartum space?

Do you have previous children? If so, what are their names and ages?

If you’ve given birth can you please share about your previous birth/births and postpartum experiences?

Do you have a particular diet? Allergies or sensitivities?

Are you currently taking any medications or seeing any health practitioners… If so, what/who?

Personal Health History

Do you have or have you had any pre-existing health conditions, physically or mentally?

Such as PTSD, anxiety, depression, bi-polar, eating disorders or other mental health conditions. Any traumas (sexual, emotional, physical), any previous pregnancies, miscarriages, terminations, etc. or any physical injuries to the body.

What are some ways that you resource yourself and regulate your nervous system? (self care/nourishment/mental health). Do you have a therapist?

Have you had any recent major life changes?

(job, house, relationship, close relation death, traumatic event)

Do you have community around you - family and/or friends?

Is there anything else you feel Nic should know? Any needs that I should be aware of to better support you in this journey together?

How did you hear about Nicole’s Doula services?