A good intake form means your first prenatal visit starts with the conversations that matter, not with collecting phone numbers. It tells you who your client is, who'll be at the birth, what they're hoping for and worried about, and how they like to be supported.
Below is a free doula intake form you can copy or download, with an optional section for postpartum clients. Under it: what each section is for, which questions to handle with care, when to send it, and how to use the answers.
The template
Edit the questions to fit your practice. Replace everything in [brackets] and delete any section that doesn't apply.
DOULA CLIENT INTAKE FORM Template from cradledapp.com/guides/doula-intake-form-template Edit the questions to fit your practice. Ask only for what you need to support your client, keep the answers private and secure, and make it clear which questions are optional. Laws about collecting and storing health information vary by location, so check the rules where you practice. Replace everything in [BRACKETS]. Delete any section that doesn't apply. ------------------------------ A NOTE FOR YOUR CLIENT Thank you for choosing [Business name]. These questions help me understand you, your pregnancy, and the support you want, so our first visit can focus on what matters most to you. Answer only what you're comfortable sharing. Anything marked (optional) can be skipped, and we can talk about any of it in person instead. Your answers stay private between us. ------------------------------ 1. ABOUT YOU Full name: Name you'd like me to use: Pronouns (optional): Date of birth: Phone: Email: Home address: Best way to reach you: [ ] Call [ ] Text [ ] Email Preferred language: Partner or main support person Name: Pronouns (optional): Relationship to you: Phone: Email: Will they be at the birth? [ ] Yes [ ] No [ ] Not sure yet Emergency contact (if different) Name: Relationship: Phone: 2. YOUR PREGNANCY Estimated due date: Is this your first baby? [ ] Yes [ ] No If not, how many children do you have, and how old are they? Are you expecting more than one baby? [ ] Yes [ ] No Care provider: [ ] OB [ ] Midwife [ ] Family doctor [ ] Other: ______ Care provider's name and practice: Planned place of birth: [ ] Hospital [ ] Birth center [ ] Home Name of hospital or birth center: How has your pregnancy been so far? 3. HEALTH INFORMATION (OPTIONAL) I'm not a medical provider, and I don't need your full medical history. If there's anything about your health you'd like me to know so I can support you well, you can share it here, or we can talk about it in person. Is there anything about your health or this pregnancy you'd like me to be aware of? Do you have any allergies (including to foods, oils, or scents)? Is there anything that's been flagged by your care provider that you'd like support with? 4. PREVIOUS BIRTHS (IF ANY) How did your previous birth or births go? Is there anything from a previous birth you'd like to do differently this time? Is there anything from a previous birth you'd like me to know, or that you'd like to talk through? (optional) 5. HOPES AND CONCERNS Why did you decide to work with a doula? What are you most looking forward to? What are you most worried or unsure about? In three words, how would you like to feel during your birth? Have you taken, or do you plan to take, a childbirth class? [ ] Yes [ ] No [ ] Planning to Which topics would you like to learn more about before the birth? [ ] Stages of labor [ ] Comfort measures [ ] Pain medication options [ ] Interventions [ ] Cesarean birth [ ] Your rights and informed consent [ ] Feeding [ ] Newborn care [ ] Postpartum recovery [ ] Partner's role [ ] Other: ______ 6. HOW YOU LIKE TO BE SUPPORTED When you're stressed or in pain, what usually helps? How do you feel about touch, such as massage or counter-pressure? [ ] Welcome [ ] Sometimes, ask first [ ] Prefer not Are there things you'd prefer I avoid (words, scents, music, kinds of touch)? Are there cultural, religious, or family traditions you'd like honored during the birth or after? Is there anything that would help you feel safe and respected with your care team? How involved would you like your partner or support person to be? 7. AFTER THE BIRTH How are you planning to feed your baby? [ ] Breast/chest [ ] Formula [ ] Both [ ] Not sure yet Who will be helping at home in the first few weeks? Are there other children or pets at home? Is there anything you're worried about for the postpartum period? Have you experienced anxiety or depression, during pregnancy or before? (optional) This helps me know how to support you and when to suggest extra resources. 8. LOGISTICS How did you hear about me? Is there anything that might make it hard to reach you or get to the birth (parking, building access, a long drive)? Is there anything else you'd like me to know? ------------------------------ POSTPARTUM DOULA SECTION (optional, for postpartum services) Baby's name and date of birth (or due date): How was the birth? How are you feeling, physically and emotionally? How is feeding going? How is everyone sleeping? What would help you most right now? [ ] Rest and overnight support [ ] Feeding support [ ] Newborn care [ ] Help with siblings [ ] Light household help [ ] Meals [ ] Emotional support [ ] Other: ______ Which days and times would you like support? Is there anything about your home I should know before I arrive (pets, parking, shoes off, quiet hours)? ------------------------------ CONSENT I understand that my doula provides non-medical support and that my answers are used only to support me. I can update or withdraw anything I've shared at any time. Name: ______________________________ Date: ____________
What each section is for
A note for your client
Start with a short, warm note. It sets the tone, explains why you're asking, and gives permission to skip anything. Clients answer more openly when they know the form is for their support, not a test.
1. About you
Contact details for your client, their partner or main support person, and an emergency contact. Ask for the name they'd like you to use and their pronouns, and their preferred way to be contacted. A client who never answers calls should be texted.
2. Your pregnancy
The due date, whether this is a first baby, their care provider, and the planned place of birth. These shape your on-call period, travel planning, and the hospital or birth center policies you'll need to know.
3. Health information (optional)
This is the section to handle most carefully. You're not their medical provider, and you don't need a full medical history. Ask an open question about anything they'd like you to know so you can support them well, plus allergies, which matter for massage oils, scents, and snacks. Keep it optional and offer to talk in person instead.
4. Previous births
For clients who've given birth before, their past experience is often the most useful thing you'll learn. Ask what they'd like to do differently. Leave space for a difficult experience, but don't push: an optional question and an offer to talk it through in person is enough.
5. Hopes and concerns
The heart of the form. Why they chose a doula, what they're looking forward to, and what worries them tells you what your prenatal visits should cover. "In three words, how would you like to feel during your birth?" is a simple question that clients often remember long after.
6. How you like to be supported
Comfort preferences, how they feel about touch, things to avoid, and any cultural, religious, or family traditions to honor. Ask how involved they want their partner to be. Some want the partner front and center, others want you to take the lead.
7. After the birth
Feeding plans, who'll help at home, siblings and pets, and postpartum worries. A gentle, optional question about anxiety or depression helps you know when to suggest extra resources. Explain why you're asking.
8. Logistics
How they heard about you (useful for your marketing), anything that could make it hard to reach them or get to the birth, and an open "anything else?"
Postpartum section
For postpartum clients, ask how the birth went, how everyone is feeling, sleeping, and feeding, and what kind of help they want: overnight rest, feeding support, sibling care, meals, or light housework. Ask about the home before your first shift: pets, parking, quiet hours.
When to send your intake form
Most doulas send it after the contract is signed and before the first prenatal visit. (Need a contract too? See our free doula contract template.) By then the client is committed, and you have time to read the answers before you meet. Before signing, a short inquiry form with name, due date, place of birth, and how they found you is enough. Don't ask a prospect for health details before they've hired you.
Give a soft deadline, such as "a few days before our first visit", and send one gentle reminder if it's still blank.
How to use the answers
- Read them before the first visit, and note two or three things to follow up on in person.
- Shape your prenatal visits around the topics they want to learn about and the worries they named.
- Bring their support preferences into the birth. Touch, scents, words to avoid, and traditions belong in your birth notes.
- Revisit them in late pregnancy. Plans and feelings change. A quick check-in at 36 weeks catches what's new.
Common mistakes
- Asking for a full medical history. You don't need it, and it creates information you're responsible for protecting.
- Making sensitive questions required. Mental health, past trauma, and difficult births should always be optional.
- Sending it too early. A long form before someone has hired you feels like a lot. Keep pre-contract questions short.
- Collecting answers and never using them. If a client tells you they're afraid of a cesarean, that should come up in your next visit.
- Leaving out the partner. Ask about their role and how involved they want to be.
Frequently asked questions
What should a doula intake form include?
Contact details for the client, partner, and an emergency contact; pregnancy basics such as due date, care provider, and place of birth; optional health information; previous birth experiences; hopes and concerns; support preferences; and postpartum plans.
Should a doula ask about medical history?
Only what helps you support the client, and always as optional. Doulas don't provide medical care, so you don't need a full medical history. Allergies and anything the client wants you to know are usually enough.
Is an intake form different from a birth plan?
Yes. The intake form helps you get to know your client. A birth plan is their list of preferences to share with their care team, usually written later in pregnancy, often with your help.
Can clients fill in an intake form online?
Yes, and it's easier for everyone. An online form is easier to fill in than a PDF, keeps the answers in one place, and you don't have to retype anything.
Send it with Cradled
Cradled turns your intake form into a template you can send to every new client:
- Start from a starter or your own. Cradled includes a starter client intake for doulas, built from a working doula's real form, as well as intake starters for lactation consultants and perinatal mental health. Copy one into your templates and edit it, or build your own with short and long answers, dates, numbers, and single- or multi-choice questions.
- Your client fills it in from her app, where it's marked "Fill out before your first appointment". Clients who don't use the app can fill it in from an emailed link.
- You're notified when she's done, so you can read her answers before your first visit.
- Everything stays together with her contract, invoices, appointments, and visit notes.
Cradled is free for 1 active client at a time, with every feature included.