What a doula includes in a client intake form to tailor personalized birth support.

Think of a doula’s client intake form as the first honest conversation with a family. It’s not just a stack of questions; it’s a small doorway into trust, a practical roadmap that helps you tailor care to real people, with real hopes and real limits. When you’re preparing to support someone through birth, that intake is where you begin to understand not just the body, but the whole story behind the birth—preferences, fears, and all the little details that influence decisions in the heat of labor.

What belongs on the intake form? The big three

If you skim the choices, you’ll notice a clear winner: you want more than a name and due date. The right form gathers three categories: medical history, birth preferences, and concerns. Ask yourself: how would you want a caregiver to understand your own journey if you were in labor? The same questions help you respond with sensitivity and relevance.

• Medical history: Think of this as the backbone. Past surgeries, chronic conditions, allergies, current medications, and any pregnancy-related health issues can change the plan in real-time. It’s not about turning a moment into a medical report; it’s about spotting anything that might affect comfort, safety, or decisions during labor.

• Preferences for birth: This is where you honor autonomy. Do they prefer certain pain management techniques? Are there positions that feel more comfortable? Who should be present, and who should not be in the birthing space? It’s not a checklist to judge outcomes; it’s a guide for advocacy, education, and support that aligns with their values.

• Concerns: This is the emotionally honest corner. Anxiety about the unknown? Previous birth trauma? Cultural or spiritual beliefs shaping the experience? Addressing concerns helps you tailor reassurance, information, and practical support. It also flags moments where extra care and communication can make a big difference.

Why medical history matters (and how to surface it cleanly)

Medical history isn’t a party trick; it’s safety fuel for the whole team. A quick line like “Do you have any medical conditions or allergies we should know about?” is not enough on its own. You’ll want a patient-friendly format that invites details without turning the patient into a medical mediator.

• Include chronic conditions (asthma, diabetes, hypertension), past surgeries, and current medications.

• Add obstetric history (previous births, cesarean scars, assisted deliveries) because past experience often signals how someone might respond to pain, interventions, or labor progression.

• Provide space for allergies, anesthesia reactions, and relevant family history when it could influence decisions.

The tone matters here. Use plain language and reassure the client that information stays confidential. Remind them that sharing this data helps you advocate effectively and tailor support to their unique needs.

Birth preferences: the map of what you want

Preferences aren’t a forecast of outcomes; they’re a compass for care. A well-constructed section on birth preferences gives you actionable insight without turning the form into a wish list that can’t bend when reality shifts.

• Pain management choices: Want to explore options like natural coping strategies, epidurals, or alternate methods? Note how they feel about pharmacological relief, and whether they’re open to discussion if plans need adjustment.

• Labor positions and movement: Some people progress better with upright positions; others feel more comfortable in side-lying or lying position. Document what has worked in past labors and what they’d like to try.

• Support network: Who should be present (partner, family, friend, midwife, or doula)? Are there anyone who should be restricted from the birthing space? This helps you coordinate with hospital staff or birth settings and prevent confusion in the moment.

• Roles and boundaries: Clarify the doula’s role (emotional support, physical comfort measures, advocacy) and how they want to be involved with staff and family members.

Conversations about concerns: normalizing fear and building confidence

Concerns are not problems to be solved with a magic wand; they’re signals about what matters most to the client. When you give space to concerns, you’re validating their experience and building a foundation for steady, informed decisions.

• Common fears: pain, loss of control, medical interventions, or unfamiliar environments.

• Past experiences: Trauma history, previous difficult labors, or negative interactions with providers—these all shape how a person approaches birth.

• Cultural, spiritual, or personal beliefs: What rituals or practices matter? Are there language preferences or accessibility needs? Addressing these helps you show up with respect and humility.

• Confidence and reassurance needs: Do they want more education on certain topics or a plan for quick updates during labor?

What not to include and why

Clarity matters more than cleverness here. Some items don’t help, and a few can erode trust if they intrude into sensitive areas.

• Personal opinions about childbirth: The form isn’t a stage to debate ideas about birth; it’s a tool for understanding the client’s preferences and needs.

• Predictions about birth outcomes: Birth isn’t a forecast you can pin down. Focus on what can be planned for and supported, not what might happen in the future.

• Irrelevant or overly broad questions: The form should be easy to answer, not a maze. If a question doesn’t serve safety, comfort, or informed decision-making, it probably doesn’t belong.

How to structure the form for clarity and warmth

A well-designed intake form feels welcoming, not intimidating. It should be easy to read, quick to complete, and adaptable as things change.

• Clear sections with gentle headers: Medical history, Birth preferences, and Concerns, each with a short introductory sentence so the client knows why the information matters.

• Mix of question types: Use checkboxes for quick, concrete data (conditions, medications), and open-ended prompts for details (past experiences, desires, concerns).

• Consents and privacy: Include a simple consent statement about how the information will be used and who will have access. Let clients know they can update the form anytime.

• Accessibility matters: Use large print options, plain language, and multilingual support if possible. A form that’s easy to read helps everyone feel included.

Putting it into action: a friendly, practical template

If you’re cultivating your own intake form, start with a clean, human-driven template. Here are a few anchor prompts you can adapt:

• Medical history: “Do you have any current or chronic conditions, allergies, or medications we should know about?”

• Birth preferences: “Are there specific pain management options you’d like to explore? Are there positions or comfort strategies you prefer or want to try?”

• Support and presence: “Who should be in the birth space with you? Are there any boundaries you’d like us to observe?”

• Concerns: “What worries you most about labor? Is there a past experience you’d like us to address or any reassurance you’d find helpful?”

• Cultural and accessibility notes: “Are there cultural or spiritual practices that are important to you? Do you need any language or accessibility accommodations?”

Then wrap it with a short note about privacy, how often you’ll review the form, and how they can update it. A simple, friendly closing helps people feel seen and respected.

A form that grows with you

Birth is dynamic, and so should your intake form be. Consider a staging approach: an initial intake sent ahead of the first meeting, followed by a quick check-in after the first conversation to add new details. You’ll find that some clients remember preferences or concerns only after you’ve started talking; a flexible form makes space for those moments.

• Build a living document: Encourage clients to revise entries as plans solidify or feelings shift.

• Use digital tools thoughtfully: A secure online form can streamline collection and updates, while still offering a human touch in your follow-up conversations.

• Keep it human: A gentle tone, a few reassuring lines, and the promise of confidential care make the difference between a checkbox and a trusted alliance.

A closing thought: why this matters beyond the form

The intake form isn’t a paperwork hurdle; it’s a gateway to tailored, compassionate support. When you know a client’s medical landscape, their birth preferences, and their deepest concerns, you’re equipped to advocate effectively, educate clearly, and respond calmly in the moment. It’s a practical tool that translates empathy into action.

And let’s be honest: the best birth experiences aren’t built on chance. They’re crafted through listening, respect, and careful planning. The right intake form makes that possible from the very first conversation. It’s the quiet backbone of thoughtful, person-centered care.

If you’re building or refining your own intake process, keep the focus on clarity, consent, and connection. A well-crafted form invites honesty, protects safety, and paves the way for supportive, informed collaboration between client and doula. And that, in turn, helps families feel seen, prepared, and ready for the remarkable journey they’re about to embark on.