Doula intake form

Doula intake form: what to ask and how to keep it organized

A doula intake form collects the background you need to support a client well: personal details, birth partner, pregnancy history, emotional wellbeing, expectations and support network. MinhaDoula includes a 9-section intake form built for doulas that you can fill in with the client or print blank, and save as a PDF.

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What belongs on a doula intake form

Keep the form focused on what helps you support the client. It is a record of what she tells you, not a medical assessment.

• Personal details, address, emergency contact and estimated due date.
• Birth partner and support network: who will be there and who helps at home.
• Pregnancy and birth history, and how she is feeling about this pregnancy.
• Emotional wellbeing, fears and what would make her feel safe.
• Expectations and preferences for birth, feeding and the postpartum period.
• Care team: doctor or midwife, planned place of birth and how to reach them.

How the MinhaDoula intake form works

• Nine sections in the doula format, so you do not start from a blank page.
• Fill it in during the first meeting, or print it blank for the client to complete.
• Save the filled-in or blank form as a PDF, with your identity on it.
• The answers live in the client's record next to her schedule, birth plan and payments, instead of in a loose document.

Keep client information private

Intake answers can include health information. In MinhaDoula the record is private to you and to the client you invite, sessions are protected and sensitive actions are logged. The form is for recording and organizing; it does not interpret anything the client tells you. The intake form is part of the Pro and Premium plans.

Frequently asked questions

What is a doula intake form?

It is the first questionnaire you complete with a new client. It records her background, support network and preferences so you can plan your support.

Can I print the form blank?

Yes. You can save it as a PDF either filled in or blank.

Where are the answers stored?

In the client's record in MinhaDoula, alongside her schedule, birth plan and payments.

Is an intake form a medical record?

No. It records what the client tells you to help you support her. It does not replace the records kept by her doctor or midwife.

Keep reading

• Birth plan template: build it with your client, not for her
• Doula client portal: support your clients between sessions
• Doula CRM: never lose an inquiry or a client detail
• MinhaDoula: doula software and CRM, with features and plans