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Before & After Baby Care
Intake form for pregnant and post-partum young moms for support. Please fill out the form so we know how we can support you in the ways you are wanting and needing. We will contact you shortly to confirm your registration.
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Name
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Your answer
Phone Number:
Your answer
Email address:
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Your answer
FB messenger contact info:
Your answer
What is the best way to contact you?
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Phone/text
Email
FB messenger
IF PREGNANT, what is your due date?
MM
/
DD
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YYYY
IF PREGNANT, how many weeks along are you?
Your answer
IF PREGNANT, how are you planning on feeding your newborn? Formula, breastfeeding, pumping & bottle feeding, a combination?
Your answer
IF NEW MOM, when did you give birth?
Your answer
IF NEW MOM, how many weeks is your newborn?
Your answer
IF NEW MOM, how are you feeding your newborn? Formula, breastfeeding, pumping & bottle feeding, a combination?
Your answer
Do you have people supporting you in your pregnancy or newborn stage? Who are those supports?
Your answer
Are you able to arrange your own transportation to YFC for the support group? (Please note: We cannot guarantee rides for all participants. If you can get here on your own/arrange a ride, that is best.)
Yes
No
Sometimes
Clear selection
Check topics you would be interested in learning more about/discussing/asking questions about:
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Breastfeeding
Bottle feeding/formula/pumping/feeding combinations
Basic baby care (bathing, diapering, rash issues, umbilical cord care, etc.)
How to navigate the hospital when you go in to give birth
What to expect in labour and delivery
Current Covid policies at hospitals
Accessing resources
Circles of support
Healthy pregnancy
Self-Care (ways to care for self while caring for baby)
Mental health (anxiety, depression, baby blues, etc.)
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