Cowichan Doula Intake

Intake Questionnaire

Please fill out the following questions with as much/little detail as you are comfortable with.

* Indicates required field

Birthing Parent's Name *

First

Last

Estimated Due Date *

Partner's Name *

First

Last

Email *

Phone Number *

Address *

Care Provider & Planned Birth Location *

What are your worries or fears about birth and postpartum? *

What role do you see your partner having in your birth and postpartum? *

What do you feel confident about in regards to birth and postpartum? *

Is there anything in particular you would like me to focus on during our prenatal visit/class? *

Is there anything else you would like me to know? *

Submit

Kaya Edwards
Pregnancy Loss & Abortion Support Doula
Birth Doula Services
Postpartum Doula Services
Prenatal Classes
cowichandoula@gmail.com
778.678.7454

Serving families in the Cowichan Valley on Vancouver Island, British Columbia on the traditional territory of the Quw'utsun nation.

As of September 1st we will be located in WhippleTree Junction!
Unit F - 4705, Trans-Canada Hwy, Duncan

Looking for a way to connect in person with other new and expecting families in the Cowichan Valley?
Here We Grow is a FREE weekly drop-in group that adheres to all social distancing protocols while benefitting from the support that in-person connection provides.
Founded in January 2020 by Kaya Edwards of Cowichan Doula, Meg Fulton of Rosewater Reproductive Wellness, and Samara Ferguson of WyldFern Doula who all have a passion for supporting families throughout their parenting journey. Weekly drop-in groups are hosted by Kaya and Samara at locations around the Cowichan Valley - for a full schedule and to learn more CLICK HERE.