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Your Doula Intake Form

Before we begin your care, I invite you to fill out my Doula Intake Form. This form is designed to help me understand your hopes, preferences, and any special considerations for your pregnancy, birth, and postpartum journey.

By sharing your story, values, and needs, you allow me to:

• Personalize my support so it’s uniquely tailored to you and your family.

• Understand your priorities for birth and postpartum care.

• Honor your emotional, physical, and spiritual needs throughout our time together.

Completing the form early in our process ensures I can be prepared and ready to support you fully from day one.

How to complete:

1. Click the link below to access the form.

2. Take your time — there’s no rush. The more detail you provide, the better I can serve you.

3. Submit it before our initial consultation by:

   1. Emailing the completed form, screenshot or typed answers to: 1000watersdoulaservice@gmail.com.

   2. Print and send photos to email above or 620.419.8952

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"In all your ways acknowledge Him, and He will make your paths straight." — Proverbs 3:6