Prenatal Questionnaire

This form is intended to help you provide relevant information before we meet so that we may spend our time having meaningful discussion about your birth vision.

I also use this form to keep track of clients' information for future reference; you may come back to this form at any time to add or modify the information.

I abide by the Heart of Illinois Doula Association's Code of Ethics and Standards of Practice. As such, I regard all personal information as highly confidential and will keep it as such, pursuant to HIPAA.

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