Holistic Doula Services with Ayoe Ingemann Lai Name(required) Birthday (YYYY-MM-DD)(required) Address(required) Email(required) Phone(required) Support person's name Birthday (YYYY-MM-DD) Email Phone 40 week gestation date (YYYY-MM-DD)(required) Do you have older children? What is their age?(required) Do you have any pets?(required) Who is your care provider?(required) If you are planning to birth somewhere other than your home, please provide details and address of planned birth location.(required) Are there any special circumstances that may affect your plans for this birth?(required) Do you or your partner have any specific concerns about your upcoming birth?(required) Any previous births, miscarriages or abortion experiences? What were they like? (required) What do you and your partner do for a living? Anything that affects your pregnancy? Stress, physical work, long hours, etc?(required) What is most important to you about your upcoming birth? How would you like to look back at it?(required) What is most important to your partner about your upcoming birth? What would they say looking back at it?(required) Do you or your partner have any spiritual or philosophical rituals or traditions that you would like to include in your pregnancy, birthing time and postpartum? (required) What steps are you taking during your pregnancy to stay healthy? Diet, exercise etc? (required) Are you seeing any wellness practitioners regularly during your pregnancy? Massage, acupuncture etc. (required) Other birth attendees. Photographer, family members etc.(required) Do you have concerns about having any of those people attend your birthing time? (required) What support would you like from each member of your team? (required) What is your idea of my role during your pregnancy, birth and post partum? (required) Is there anything else you would like me to know before we begin to work together? (required) I work with crystals, candles, essential oils, sage and incense burning. Do you have any concerns with any of those? (required) How did you find me?(required) Payment plan details: option one is to pay in full up front, option two is to split it 50% now and 50% when you are 37 weeks gestation. Please indicate how you will pay.(required)Service agreement:I will do my absolute best to support you and your partner during your pregnancy, birth and post partum. In order to do so, it is important that you inform me after every visit with your healthcare provider and if something needs to be addressed.Please email me any questions or concerns prior to our sessions so I can provide the best service for you and your partner. I can help you the best when you include me in the loop of your other birth attendees.Due to the nature of birthing work, I may not always be able to respond to emails right away. If you do require urgent access to me (when having your baby) please call me (604 440 9680). If it is a non-urgent matter I will usually be able to respond during daytime on weekdays. Please check below to indicate that you have read and agreed to the terms outlined in the service agreement.(required)Submit Δ
