A doula intake form built around support, not diagnosis

Written for doula work, not borrowed from a clinic

Most doula client intake form templates online are a medical history questionnaire with the word doula added, which is doubly unhelpful: it collects clinical information a doula does not act on, and misses almost everything that shapes how you actually support someone. This preset starts from the work. Who the client is and who else will be in the room. What kind of support they want and what they definitely do not. The practical logistics that make on-call arrangements workable. It carries two modes — a birth doula intake form by default, and a postpartum mode when the work begins after the baby arrives — in one document, so a doula offering both is not maintaining two files. Editable throughout, PDF available immediately, no signup.

• Built for HIPAA-compliant workflows

• Free to start — 50 patient actions each month

Support team, preferences and logistics

Three sections carry most of the value. The support team records everyone involved — partner, family members who will be present, the care provider and practice, where the birth is planned, and whether a backup doula has been discussed and who that is. Preferences captures what the client wants from support in their own words: comfort measures they think will help, what they want you to do if things become difficult, who speaks for them if they cannot, and anything they want you to avoid. Logistics is the unglamorous part that makes the arrangement work: on-call dates, travel distance and parking, other children and pets, who else has a key, and how they prefer to be contacted at three in the morning. None of this appears on a medical form, and all of it is what a doula actually needs.

Postpartum mode, for work that starts after the birth

Postpartum support asks different questions, and a postpartum doula client intake form built on a birth template misses most of them. Switching modes changes the document accordingly: household composition and who else is helping, feeding plans and what support the client wants around them, sleep arrangements and how the family is currently managing nights, older siblings and their routines, practical tasks the client would find most useful, and the shift pattern and dates being arranged. It also asks how the client is finding things in their own words, with room to write, and a space for the practice to record its own approach to when a family should be encouraged to contact their care provider — wording your practice writes rather than any that ships with a template.

Edit it, then download exactly what you built

Rename the form, rewrite any question or piece of helper text, mark fields required or optional, switch between birth and postpartum modes, and add, duplicate, reorder or remove sections. Tone matters here as much as content, since this is often the first written thing a client receives from you and warmth is part of the service. A default PDF is ready as soon as the page loads, and after any change a new PDF is generated from your current version. It prints on US Letter with room to write properly, and reset restores the original preset whenever you want to begin again.

A solo doula, one evening

A doula offering both birth and postpartum support starts from this preset. She sets birth as her default and keeps postpartum a mode switch away rather than a second file. She expands the preferences section after realising the question she most wants answered — what would you like me to do if you change your mind about something — was not on her old form at all. She adds a line about pets, having once arrived at three in the morning to an anxious dog nobody had mentioned. She removes a medical history block she never used. She writes her own paragraph about when to contact a care provider, and keeps her client agreement as the separate document it has always been. One evening, and her intake finally matches how she works.

Non-medical scope, stated plainly

Doula support is non-medical, and this form is built to respect that rather than blur it. It does not screen for complications, assess maternal or fetal wellbeing, triage anything, suggest a diagnosis, or recommend an intervention — none of which fall within doula scope of practice, and a form that invited them would be doing a client a disservice. Where information genuinely belongs with a midwife, obstetrician or paediatrician, the form's job is to record what the client tells you and to make it easy to encourage them toward their care provider, which is your practice's wording to write. It also asks for noticeably less than a clinical form would. Collecting a full medical history you will never act on creates risk for a client and work for you, so the preset stays with what supports the arrangement and leaves the rest to their care provider — add a sensitive question only where you have a use for the answer. This is an original document rather than a copy of any published or association form. Your client agreement, covering fees, cancellation and the terms of your relationship, is a separate legal document and deliberately not bundled here. Have your professional body's scope guidance and your attorney inform both. DocRepute is HIPAA-focused and built for HIPAA-compliant workflows, and as this is a public tool, build the blank form here rather than entering real client details.