Inclusive Infant Care- Intake Form  
Hello, and thank you for inquiring about my Newborn Care services! Please fill out the form below so I can understand what services you are looking for, and how best I can support you, your family and your new bundle of joy! I seek to provide a SAFE and INCLUSIVE space for all those that I support especially LGBTQIA+ families, families from marginalized communities, and single parents. I dedicate myself to holding a safe, and calm space for all clients, regardless of background, income, race, religion, sexual orientation, gender identity, and family structures. 

Once you fill this out, I will reach out to schedule your FREE 20 minute Zoom meeting consultation. 

Thank you, 
Johanna Forney

I am located in Westchester County, NY, and I serve the following areas: Westchester County, Rockland County, Orange County, Northern New Jersey, Connecticut and wider areas. 

I am willing to travel for a long term/short term position live in position. . Please include that in your last response. 


Services Provided: 
  • Overnight support
  • Daytime Support
  • Preparing small snacks
  • Lactation/ Chest feeding support

  • Infant feeding information/support

  • Newborn education

  • Creating time and space for new parents to meet their own needs

  • Light cleaning and tidying

  • Direct Support For Birth Parent Post Partum

  • Washing Newborns Laundry
  • Preparing Crock Pot Meals
  • Sibling Support
  • Food Shopping



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Email *
Name *
Pronouns *
Due Date/ Support Date *
Phone Number
What is the best way to reach you?
Clear selection
What time/day of the week works best for your consulation ? 
What kind of consultation would you like ? 
Clear selection
How did you discover my website/business ? 

Word of mouth
Referral
Search engine
Agency
Google
Facebook
Instagram 
 *
What type of Doula support are you looking for? 
Are you utilizing any insurance benefits? aka Carrot, HSA/FSA, etc *
Will you be using soothing techniques such as swaddling, pacifiers, white noise, etc  *
How many days a week/ hours per shift are you looking for support?  *
How long are you looking for newborn support?  *
Where are you located?  *
What is your plan for feeding your baby?  *
Are there pets in the home? 
how long is your maternity leave? if you have a partner, how long is their leave?  *
Are members of the household up to date with vacinations/boosters? 
Tell me a little about yourself, your family, and your new little joy! When is their estimated due date? Is this your first child? 
What will your support structure look like post birth? (extended family close by/far away, heavily involved or not, etc)  *
What, if any, infant education have you experienced? That could be podcasts, books, online classes, one on one coaching classes, birthing class, infant care classes, youtube videos, or none of the above! No judgement at all!  *
Are there any specific areas of newborn care that you’re worried about, or would like extra support in? (lactation, feeding, soothing etc)  *
Lastly, are there any things about your family/household that are important for me to know? (Allergies, cultural/religious practices, medical conditions, food safe practices etc)  *
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