Rest into Care 
Please fill out the intake form below. You can always change your mind later but for now I want to hear a little about you. Please answer to the best of your knowledge today and know you will have time to tell me more as we build a foundation of trust. 
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Email *
Name *
Partner name(s) *if partnered or co-parenting *
Email *
Address *
Phone number *
EDD *
Name of PCP/OB/CNM
List any groups you identify with? (Ex: LGBT/BIPOC/Disabled) *
What is your experience with birth outside of the hospital? *
Briefly tell me about your choice for a home birth? *
What are your goals for a home birth? *
Do you plan to have a doula? *
Who/what are your support systems for pregnancy and postpartum? (ex:friends, family, savings, pets...) *
How is your partner feeling about a home birth? *
How does your family (chosen or blood) feel about you having a home birth? *
How did you hear about us? *
What are 3 good days and times for a 15-30 min consultation? (ex: Tuesdays 1-530pm) *
You Made it! I know these things aren't always fun
Once I have received your intake I will contact you within 48 hours to schedule a consultation with me. During our consultation I will tell you more about me and the care I provide, go over starting care and you can ask me questions.
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