Your name:
*
Your estimated due date:
Your partner's name (if applicable):
Your kids' names and ages (if applicable):
Do you have pets in the house? If so, what kind?
Does anyone smoke or vape in the home?
Do you have a job outside of being a parent? If so, what is your job?
Will you be returning to work? If so, when do you plan on doing so?
Will your partner be taking time off of work? If yes, how much time?
Do you have any postpartum support already in place? If so, please tell me a bit about it.
Do you plan to pump breastmilk to use for bottle feeding?
Do you plan to breastfeed, formula feed, or both?
Where are you planning to give birth?
What is your midwife or OBGYN's name?
Are you seeing any complementary healthcare providers during your pregnancy? If yes, what are their names?
Are there any baby care or parenting techniques that you plan to use or have questions about?
What are your primary goals in hiring a postpartum caregiver?
What is the most important thing for you and your partner regarding hiring a postpartum caregiver?
Are there any medical concerns that you feel I should know about?
Do you or your partner have a history of depression, anxiety, or other mental health issues?
Do you have any fears about your upcoming birth, postpartum, or parenting?
Please mark the services you are most interested in so I can make sure to prioritize them during our time together. Check as many as you'd like.
Is there anything else that you'd like me to know, or anything else that you'd like for us to talk about?