IMAGES
BIRTH IMAGES
CONTACT
They Call Us Wild
Katie Mathis Photography
IMAGES
BIRTH IMAGES
CONTACT
BIRTH CLIENT QUESTIONNAIRE
Client Information
Mother's Name
*
First Name
Last Name
Partner's Name
First Name
Last Name
Date
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email Address
*
Mother's Phone
*
Partner's Phone
Emergency Contact
*
First Name
Last Name
Relationship to Emergency Contact
*
Emergency Contact's Phone
*
Birth Information
Estimated Due Date
*
MM
DD
YYYY
Doctor &/or Midwife's Name
*
Birth Location
*
Birth Location
Home
Hospital
Birth Center
Name of Birth Location
*
Birth Location Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Is this your first baby?
Yes
No
Labor Method
Spontaneous Labor
Planned Induction
Planned Cesarean
Have you spoken to your doctor about having a photographer at your birth?
Yes
No
In the event of a C-section, have you spoken to your doctor about allowing photography in the OR?
It is your right to include me in on your experience, YOU need to tell your birth staff if you want me in the OR.
Yes
No
What are you most interested in at this time?
*
Birth Photography ($1,595)
Birth Photography and Videography ($1,895)
Want to build a package? What additional services are you most interested in?
Birth clients receive additional services for a discount when bundled and bought as a package.
Maternity Session
Milk Bath Session
Baby Shower/Blessingway Coverage
Newborn Session
Fresh 48 Session
Family Session
First Year Milestones (Newborn, 6 Month, & 1st Birthday)
Breastfeeding Session
Will you have a doula or other support team present?
Yes
No
If so, please list their name:
Please list the family that will attend your birth (Any grandparents, etc. This helps with photos so we know who to look for.)
*
Anything you would like us to look know about your birth, labor plans, doctor, hospital, etc.
Thank you!