Birth Story Questionnaire

First Name *

Last Name *

Phone Number *

Email *

Partner’s Name *

Partner’s Phone Number *

Address *

Estimated Due Date *

Location Type *

Location Address *

What is your current birth plan? *

Current pregnancy: Check any that apply. *

Care Provider *

Name of Practice *

Phone Number *

Who will be your attending birth workers? *

Have you notified your team that you’ll have a professional photographer attending your birth? *

Do you plan on having your children present at the birth? Please list names and ages. *

Please list any other people who may be present during the birth. (Other family members, pets, videographer...) *

Which particular elements of the labor and birth would you specifically like me to capture? *

Ideally, how would you like for me to capture the “crowning moment”? *

From the side From mama's viewpoint Crowning view No preference

What other elements of the labor and birth are important to you for me to capture? *

Are there any goals or details within your birth plan that you would like to share with me? *

Would you like me to leave the room during particular situations or procedures? *

If for any reason you are to be transferred from home to hospital or from one hospital to another, would you want me to: *

If any emergency situation does happen, do you want me to continue documenting? *

Please specify any laboring techniques you will possibly use. (hypnobabies, birth pool, epidural, etc.) *

Any specific practices that will be performed? (delayed cord clamping, lotus birth, etc.) *

Use of Flash *

Lighting during birth is generally low and this affects the quality and clarity of images, such that they can appear grainy and sometimes very soft. I always prefer to use natural light but there are certain times when it may be preferable to bounce a flash to throw sufficient light into the shot to make the picture look less grainy and increase sharpness. Are you okay with flash being used sparingly in these situations?

Privacy *

As you probably know, social media is my greatest tool for sharing my work. I would love the opportunity to share your (non-revealing) birth images in my portfolio and with my followers. Obviously this decision is always up to you. How do you feel about images being shared on my website or social media? (There will also be a model release form where we can discuss this more in depth)

Birth Stories will be something you will treasure forever. What is most important to you for me to capture? *

Is there anything else you'd like to add? *