Questionnaire — wildbyhabit

Birth Questionnaire

Take a moment to share your thoughts around how you want your birth experience documented.

This will give us a better sense of what you are looking for so we can create your film/Photos to your vision.

Name

First Name

Last Name

Name

First Name

Last Name

Best contact number

(###)

###

####

Emergency Contact

Name & Best Contact Number

Estimated Due Date

YYYY

Birth Location

Home

Hospital

Birth Center

Birth Address

State

Postcode/Zip

Have you spoken to your Doctor/Midwife about having a photographer attend?

Yes

Not yet

In the event of a C-section, have you spoken with your doctor about allowing photography in the OR?

Yes

Not yet

Will you have a doula or other support team member present?

If yes and you are comfortable sharing my info with them, I would love to connect.

Yes

1. Tell me a little bit about yourself and everyone included in your birth. Please include first names, last names and pronoun.

2. What moments are you most excited for me to capture?

3. What are some of your fears around your birth (if any)?

4. Tell me the story of how you and your partner met?

5. What are your boundaries for me?

For example: Close and personal during birth or you would like a wider angle of birth.

6. What kind of energy would you like for me to bring to the space?

I am a Certified Reiki Master and enjoy clearing the space to welcome baby into your space.

7. For home births, are there any rooms that are off limits?

8. For home births, Are there any special objects or spaces that you would like for me to highlight?

9. What do you want to see and feel when you look back at your film?

10. Is there anything painful or a struggle of any sort happening in your family I should be aware of or sensitive to right now?

If yes, please explain if you're comfotable telling me

11. Is there anything else you would like to share with me?