A doula intake form, question by question

What is a doula intake form for?

A good intake form is not a data-collection exercise. It has one rule: every question either changes what you do at the birth, or it does not belong on the form. The address is there because you will drive to it at three in the morning. The provider's early-labor protocol is there because it decides when you leave your house. If a question cannot pass that test, it is clutter, and she will feel it as clutter.

Built that way, the form replaces three things you are probably using now: a notebook with a page per client, a text thread you scroll back through looking for what she said about her last labor, and the habit of asking the same question at every visit because you cannot remember whether you already asked it. The 44 questions below are the ones a working doula settled on after enough births to know which answers she actually reached for.

When should you send it?

After she hires you, and before the first prenatal visit. That window matters more than the questions do, and almost nobody says so.

Send it at the consult and it reads as paperwork. She is still deciding, she does not know you yet, and she is being asked about her fears and her last labor by someone she may not hire. Most people answer that form briefly, or not at all. Send it after the contract and the whole thing changes. She has chosen you, so the questions read as care rather than screening. She fills it in at her own pace, at home, and the private questions get honest answers because writing is easier than saying.

Then the first prenatal visit stops being an interview. You arrive having read that her last labor was thirty hours, that she is not sure about her provider, and that she does not want her mother in the room. You spend the hour talking about those things instead of collecting them.

The questions most intake forms miss

Most templates cover contact details, the due date and the birth setting, and stop. Five questions on this form do the work the others do not, and each one matters at a specific hour.

Did you choose your provider, and are you comfortable with them?

Some clients picked their midwife after three interviews. Some were assigned an OB by their insurance and have met them twice. Those are different rooms to walk into, and knowing which one you are in changes how much advocacy she will want from you and how much she will want to do herself.

When does your provider want to be called in early labor?

Contractions five minutes apart, lasting a minute, for an hour. Or when the water breaks. Or something else entirely for a VBAC or a planned induction. This is the instruction that decides when you get in the car, and it is far better learned from a form at 34 weeks than from a phone call at 2am.

What happens if you go past your due date?

A provider who schedules induction at 41 weeks and a provider who waits to 42 give you a different on-call window. Her answer here tells you when your window really closes, and whether an induction is likely to change the shape of the birth you are preparing her for.

Is there anyone you would not like present?

A mother-in-law, a sister, a friend who has invited herself. Nobody says this out loud at a prenatal visit with her partner in the room. On a form, alone, she writes it down. Then you know whose job it is to keep the door.

What has been comforting in pain before?

Some people want a hand on their back the whole time. Some want silence and to be left alone. Some want someone talking them through every contraction. She has been in pain before and she knows which she is, and that one sentence is worth more to you at transition than anything else on the page.

What does not belong on an intake form

Some templates run to nine documents: an intake, a questionnaire, a consent form, a photo release, a fee agreement, a cancellation policy. Most of that is one document pretending to be several, and it belongs in the contract, not here. The difference is simple. An intake form collects answers. A contract collects a signature.

• Scope of practice and what a doula does not do. That is a term she agrees to, so it goes in the contract.
• Photo and video release, and testimonial permission. A permission needs a signature and a way to withdraw it. Contract.
• Fees, deposit, balance date, cancellation and refunds. Contract, every time. An intake form with a fee schedule on it is a contract without a signature line.
• Her birth plan. That is a document she writes for her care team, not an answer she gives you. The form asks whether she has one, and you build it together at a visit. Families can use the birth plan builder for that.

If you do not have a contract yet, the doula contract generator builds one with your own on-call and payment dates, and emails it to you as a PDF to print and sign. Send that first. Then send this.

After it comes back

Read it before the visit, not during. The point of sending it early is arriving with the questions already in your head. Look for the one she skipped: an empty box under "fears or concerns" or "anyone you would not like present" is usually not an absence of an answer. Ask about it gently, once, and let it go if she leaves it.

Then keep it where you can find it at the birth. Not in an email thread, and not in a folder on a laptop that is at home. A form you cannot open from your phone in a hospital corridor is a form you filled in for nothing. If it holds health information, keep it somewhere you would be comfortable defending. Our note on doulas and HIPAA covers what that means in practice.

Get the PDF, or send it from DoulaFlow

Enter your email above and we send you the form as a PDF: a clean blank with the notes left out, so a client can fill it in by hand. Print one per client, or attach the PDF to an email yourself.

The other way is to let the form do its own filing. In DoulaFlow you open a client and click Send intake form. She gets a link by email, fills it in on her phone with no account and nothing to install, and her answers land on her record instead of being retyped off paper. That works during the free trial, with no card. There is nothing to subscribe to before you can use it.