Name *

First Name

Last Name

Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Estimated Due Date *

If you do not know at this time enter any date with the year 1998.

MM

DD

YYYY

Partners Name *

First Name

Last Name

Have you taken any childbirth preparation classes? *

Yes

No

I am scheduled for one with IM or another company.

I would like to know what IM has to offer.

Have you made a birth plan? *

Yes

No

I'd like help with this

Have you ever felt unsafe in a sexual encounter?

Yes

No

Photographic Release *

If you are receiving birth photography services from me, I would love to share these beautiful moments on my website and social media platforms, with your consent. Please let me know your preferences below, or if you would like to discuss further. The same applies if you have another photographer. In the event we take a photo together, I would be delighted to share it and show my friends and family the joy I had in supporting you!

Yes, I consent!

No, thank you. I am Flattered!

Let's chat more about this!