Prenatal Class Questionnaire

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

* Indicates required field

Mother's Name *

First

Last

Estimated Due Date *

Partner's Name *

First

Last

Email *

Phone Number *

Address *

Care Provider & Planned Birth Location *

What are you hoping to learn in this prenatal class? *

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

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

Is there anything I can do to help you feel comfortable during the class? *

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 class? *

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

Do you already have: *

Car Seat Exercise Ball Swaddling Blankets/Sleepers

How would you like to pay? *

*Don't forget to book a time and day that work best for you HERE.*

Submit

Cowichan Doula, Cowichan Doulas, doula, doulas, Kaya Edwards, Rhondda Jones, Meg Fulton, Duncan, Matraea, Cowichan, Vancouver Island, birth, postpartum, sibling, antenatal, baby nurse, baby, twins, c-section, natural birth, hospital birth, homebirth, home birth, water birth, epidural, doula agency, matraea doulas, matrea, midwives, shawnigan, cobble hill, mill bay, cowichan bay, lake cowichan, youbou, ladysmith, nanaimo, crofton, doulas, backup doula, on call doula, oncall doula, overnight, night nanny, nanny, sibling, babysitting, babysitter, prenatal classes, childbirth, childbirth education

All three Cowichan Doulas are members of the Mid-Island Doula collective.

Kaya Edwards, Rhondda Jones,
& Meg Fulton
Antenatal Doula Services
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.