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
Car Seat Technician
cowichandoula@gmail.com
778.678.7454
Serving families in the Cowichan Valley on Vancouver Island, British Columbia.

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.