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Lotus Doula Tribe-Postpartum Care
Help us customize the perfect postpartum care for you and your family
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Name
Your answer
Email
Your answer
Cell
Your answer
Home Address?
Your answer
Estimated Due Date
MM
/
DD
/
YYYY
Todays date
MM
/
DD
/
YYYY
Birth place
Hospital
Home
Birthing Center
Clear selection
Partners Name
Your answer
Children and Pets?
Your answer
What times are best for your postpartum visits? Morning/Afternoon/Evening?
Your answer
What are your birth plans? How are you preparing?
Your answer
What kind of Parental Leave do you or your partner have?
Your answer
What kind of support do you have from family and friends?
Your answer
How will your partner support you?
Help with Siblings
Night time support
Food Prep
Breastfeeding support
Diaper Changing
Groceries
Other
All of the above
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Describe other sibling care
Your answer
Will you be wanting visitors? How long would you like them to stay? (30 mins, 1hr, ect)
Your answer
Do you need a meal train organized to?
Yes
No
Maybe?
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Describe or list any food preferences, dietary allergies or restrictions or aversions?
Your answer
Current feeding plans for baby?
Breastfeeding
Formula bottle feeding
Pumping/bottle feeding
Combination
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Did you take any Birthing Classes and/or Preparation
Your answer
Do you have any spiritual or faith preferences in your family? Share what would be most helpful for your care.
Your answer
Share a little about your home situation
Your answer
Describe household chores you would like help with.
Your answer
What are your most important wishes and concerns about the postpartum period?
Your answer
Choose other healing techniques you'd enjoy during our postpartum time together
Belly Binding
Warm Oil Massage
Baby Massage
Herbal Sitz Bath
Baby Swaddling
Postpartum yoga
Will you need community support (New Moms groups ect)
Yes
No
Maybe
Clear selection
Share any other needs or wishes
Your answer
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