Baby Moon Birth & Wellness Intake Form

Welcome! I'm Cathleen 

I'm a Certified Full Spectrum Birth Worker specializing in Postpartum Healing Care. I'm also a Sound Healer, Integrative Wellness Coach, Student Midwife, and Culture Preservationist. My passion lies in Holistic Care, supporting the overall well-being of women throughout their entire birthing journey and beyond. I'm here to guide, empower, and walk alongside you on this sacred path of motherhood.

Thank you for considering my services!

To help me understand your needs better, please take your time and thoughtfully complete the form below. If something doesn't apply to you, simply write "NA." Once I review your form (within 24-48 hours), I'll be in touch with additional information.

Have questions or want to chat?

Feel free to reach out! A quick call can help us see if my offerings align with what you're looking for.

Learn More:

With Gratitude,

Cathleen

Your Sistar in Wellness

Email *
First and Last Name? *
Whats the best way to connect with you? *
What type of Birth support are you seeking? *
Required
If currently pregnant, is this your first, second or third pregnancy? *
What is your EDD (expected date of delivery) / Date of Baby's Birth? *
What City & State are you Birthing in AND OR what city and state do you live in?  *
What is your vision for your birth? *
Who is your care provider(s)? What is the name of your OB or midwife or endocrinologist? - Write NA if not applicable *
If you are pregnant, are there any health concerns that you are facing this pregnancy? ie pre-diabetic, high blood pressure. Write NA if not applicable *
What experiences (if any) have you had related to childbirth? What stories or myths about birth have shaped your current views? *
What are you looking for from a birth or postpartum support person? What type of person? *
Are you considering breastfeeding? *
Do you have an idea of the type of birth experience you desire? *
Do you have any fears around birth or experienced any traumas in previous births?  *
If you answered yes in the previous question would you like to share? *Any information shared here is safe guarded and will not be shared. *
How would you describe your current eating habits? *
Are there any special considerations or anything else you'd like me to know as we procure support for you? *
If you are seeking postpartum support, what do you anticipate your needs will be after the birth of your baby? ie, lactation support, diapering, infant care etc - Write NA if not applicable *
Have you had symptoms or experienced postpartum depression, PTSD, postpartum anxiety, if so please share your experience. *Any information shared here is safe guarded and will not be shared. Write NA if not applicable *
For Postpartum Care Services ONLY: Does your family have a certain particular cooking style? Special Dietary needs/restrictions? ie non dairy, vegetarian, vegan. Write NA if not applicable  *
What is your budget? Please Note a 25% is given off Postpartum Services if selecting birth & postpartum support with me.  *
Are you interested or in need of financial assistance or interested in support at a reduced cost? (pls note ONLY Westchester County families can be considered at this time)  *
Required
Are you interested in any other services as an add-on option? *
Required
Anything else you'd like to share? If not, please write "N/A" in the space below. *
How did you find me? *
Who can I thank? Name of Person who referred you to me. Please write "NA" if not applicable *
I understand that the answers I have provided and the information disclosed is confidential and secure. My information will never be shared with third parties. I realize that my information will only be utilized internally to find the best possible match for support. *
Required

Cathleen Benjamin, a Haitian American woman born and raised in Rockland County, NY, embodies a rich lineage of strength and resilience. Descending from a powerful line of women – her grandmother Vada Rose Nemorin, great-grandmothers Urcelie Dumé, Inonica Barthelemy, and Alicia Celestin – Cathleen carries the wisdom of her ancestors.

A wife and mother of three, Cathleen is a multi-faceted entrepreneur and wellness advocate. Driven by a deep desire to support women on their journeys, Cathleen is a graduate of the Institute of Integrative Nutrition. She is a master manifestor, guiding women in envisioning and achieving their goals, including supporting expectant mothers in creating their ideal birth experiences. She is also a sound healer, offering calming modalities to find center, deep meditative and relaxation with crystal singing bowls, chimes. 

As a Certified Full Spectrum Birth Worker, Cathleen champions physiological births, emphasizing the sacredness of the birthing process and the importance of postpartum healing. She sits at the feet of elders and traditional midwives and passionate about preserving traditional Haitian herbal practices and cultural wisdom to support women's maternal health.

Cathleen is the CEO of Wholly & Healed, an online boutique dedicated to offering products and services that inspire healing and raise consciousness. Through 1:1 coaching and co-facilitated Divine Sisterhood Circles, she empowers women from all walks of life, reminding them of their inherent strength and the importance of self-care.

Cathleen's journey is a testament to the power of ancestral wisdom, personal growth, and a commitment to serving others. She is an ever-evolving soul, inviting others to join her on the path of healing and transformation.

A copy of your responses will be emailed to the address you provided.
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