Name *
Partner's Name
Partner's Name
Partner's Phone
Partner's Phone
Estimated Due Date: *
Estimated Due Date:
If you have other children, what are their names and ages?
Location address: *
Location address:
Name of practice: *
Name of practice:
Phone number of practice
Phone number of practice
People in attendance *
Check any that apply.
Current pregnancy *
How is it progressing? Check any that apply.
Past labors *
If this is not your first labor, can you please describe how your past labor/deliveries have gone? Check any that apply.
If for any reason you are to be transferred from home to hospital or from one hospital to another for any reason, would you want me to:
In the event of an emergency involving baby or mama, do you wish for me to continue photographing (as long as it does not interfere with birth place policy).
Let's talk about pictures during your labor and delivery *
As I'm sure you are well aware, my work is photo-journalistic in nature. However, if there are any specific types of shots you would like documented, please check them below and I will do my best to produce these if the situation allows. Check any that apply.
If applicable, please provide information regarding any birth photography restrictions that you are aware of.
I want most of my pictures to be of: *
Lighting inside of the birthing area may not be ideal or consistent for photography, and may cause the images to become grainy and lose clarity. In certain situations, it may be helpful for me to bounce a flash to add sufficient light to the shots and increase clarity and decrease grain. I will do my best to discern when it is appropriate to use my flash, and ensure that mama and baby will not be affected by its use. Do I have your permission to use the flash or turn on any overhead lights in these situations?
I will do my best to be sensitive and aware of when it's appropriate to be in the birthing space, and when to step away. *
Would you like me to leave the room or not continue shooting during any particular examinations or procedures?
As you probably know, social media is my largest tool for sharing my work. I would love the opportunity to share your (non-revealing) birth images in my portfolio and with my followers. But, ultimately, the decision is up to you. Do you want to be tagged in images on social media?
Would you like me to post a birth announcement and/or birth story blog post about your birth experience? *
A birth announcement would be posted to Facebook within 48 hours of your birth experience and a blog post would be published within a few weeks.
How do you plan on utilizing your beautiful images? *
This is a good place to express anything you happen to be self-conscious of, preferences regarding specific configurations, or editing style (if you prefer B&W vs. color edits for instance)
I understand that birth is unpredictable in nature and that although I have provided the information to the best of my ability, birth plan and location may change. I am responsible for contacting my photographer and providing timely notice of birth plan changes. *