Night Doula Parent Questionnaire 
Thank you for considering my night doula services. To ensure that we are a great fit and to provide the best possible support for your family, please take a few moments to complete this application. Your responses will help me understand your needs, parenting style, and preferences. Please answer thoughtfully and think about yourself and your feeling at this present moment. If a question does not apply to you, please use n/a. 
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Phone Number *
Home Address  *
Due Date or Baby's Birth Date *
MM
/
DD
/
YYYY
Who are the members of your household?
(Please include ages of children, if any)
 *
Do you have any pets? (Please specify type and amount) *
How would you describe your parenting style? Or desired parenting style, if applicable? (e.g., attachment parenting, routine-based, flexible, etc.)  *
Have you taken any Prenatal Classes? (breastfeeding, newborn care, etc.) *
What are your primary goals and expectations for having a postpartum doula? Why is investing in an overnight postpartum doula important to you? 
 *
How do you plan to feed baby or babies? 
 *
Are there any medical concerns you feel I should know about?
 *
Do you have a history of depression or other emotional disorders?
 *
Are there any known allergies in your family?
 *
Do you have any fears about your upcoming birth, postpartum, or parenting?
 *
Do you have any specific concerns about how your relationship with your partner might change after having a baby? In these situations, how do you envision your postpartum doula helping you cope and navigate these challenges?  *
Are there any specific strategies or types of support you would find most helpful during difficult times? 
 *
How do you feel about sleep training? And if you are interested in sleep training, what methods or approaches do you prefer or are considering? (e.g., Ferber Method, gentle sleep training, no-cry approach, sleep shaping, etc.) *
How would you describe your family's lifestyle and daily routine?  *
What values or principles are most important to you in raising your child? 
SCENARIO: It’s been a particularly difficult night, and your baby is very fussy and unsettled. In addition to your baby’s needs, there are other household members who are being disturbed by the noise. How would you want your night doula to manage this situation, considering both the baby’s needs and the rest of the household? What approaches or solutions would you be comfortable with?
SCENARIO: You’ve had a long, exhausting day and are feeling particularly stressed and overwhelmed. As the night progresses, your baby is unusually fussy and you’re finding it hard to cope. How would you want your night doula to support you in this situation? What kind of emotional and practical support would you expect or appreciate most?
What does your dream postpartum journey look like? Tell me how you imagine this…
 *
If you were your baby how would you like your postpartum doula to be characteristic wise? This could be someone warm, soft, quiet, loving, etc. Think about it, and tell me WHY? 
 *
What type of personalities do you find mesh well with yours? Can y0u describe the kind of person you envision being by your side during the night to support you and your baby? 
What do you need to know or feel before choosing a postpartum doula? How will you know that a particular doula is right for you? What kind of initial interactions or conversations would help you feel confident in your choice?  *
What emotions are important to you, how do you want to feel during your postpartum journey? Do you want to feel supported, nurtured, loved, grounded, powerful?
 *
How do you NOT want to feel? 
 *
What movies, books, or blogs have you been interested in to prepare you for this baby? 
 *
How did you find about the overnight postpartum services? What made you think “This is what I want!”?
 *
Where will the doula be staying during the night? (e.g., separate bedroom, shared bedroom with the baby, living room etc?) *
Anything else that you feel is vital for me to know about you? Or anything you would like to share? 
How did you hear about us? 
 *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms