Name *

Please include preferred pronoun(s).

First Name

Last Name

Phone

(###)

###

####

Partner's Name

If applicable. Please include preferred pronoun(s).

First Name

Last Name

Partner's Phone

(###)

###

####

Estimated Due Date: *

MM

DD

YYYY

Past labors *

If this is not your first labor, can you please describe how your past labor/deliveries have gone? Check any that apply.

This is my first labor

Preterm labor

Within 1 week of EDD

1+ week past EDD

Within a few days of EDD

Quick

Even pace

Slow

Natural

Induction

Scheduled C-section

Emergency C-section

Preterm baby

Mom interventions

Baby interventions

Other

Current pregnancy *

How is it progressing? Check any that apply.

Normal with no complications

High risk

Preterm labor/dilation

Some complications, but no concerns as of now

Other

Location address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of practice:

First Name

Last Name

Phone number of practice/ care provider:

(###)

###

####

Who will be there? *

Check any that apply.

Partner

Grandparent(s)

Doula(s)

Sibling(s)

Friend(s)

Midwife

Videographer

Photographer

Other

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.

Labor

Partner support

Family in attendance

Bonding moments with specific family members

Care Providers- with permission

Nudity ok

Nudity not ok

Crowning shot

Side shot during delivery

Over the shoulder during delivery

The placenta

Nursing

First Bath

Weight/Height

Footprints

Family with baby

Images with care providers and/or nurses

Other

I want most of my pictures to be of: *

My labor experience (my team helping, different positions I try, the overall scene throughout my laboring)

The moment the baby comes out (everyone's reactions, the baby!)

My sweet, new baby (at arrival, but also perhaps a small photo session a little while later)

I'd really just like a good mix of everything!

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?

Vomiting

Check ups

Internal examinations

Emergency situations

Epidurals

Other

How do you plan on utilizing your beautiful images? *

Framed prints

Canvas prints

Announcements or greeting cards

Photo album

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. *

I understand

Please contact me to discuss this further