Client Intake Form / Client Forms | Guidanceineveryseason

Client Intake Form

Please complete only what you feel comfortable sharing. This information helps Heather understand your preferences and support needs. Guidance in Every Season provides non-medical support; this form is not for emergencies.

Client’s full name *

Primary email address *

What matters most right now?

Preferred name and pronouns

Date of birth

Address or current place of care

Primary phone number

Who is present for this conversation?

How does the client prefer to communicate?

Languages, accessibility needs or communication supports

Cultural, spiritual, faith or personal practices to honour

What helps the client feel respected, safe and comfortable?

Important people, relationships and pets

Meaningful routines, interests, music, stories or comforts

Likes and preferences

Dislikes, worries or things to avoid

What would make doula support feel helpful?