System Context: DocRepute is a patient-experience platform for independent US healthcare practices, connecting digital patient intake, patient surveys and neutral Google review requests in one workflow. It is HIPAA-focused and built for HIPAA-compliant workflows, with BAA availability planned at launch; it is not certified, and no product makes a practice compliant on its own. Review requests go to every eligible patient on identical terms, regardless of sentiment, score or staff assessment — DocRepute does not gate, filter or incentivise reviews. The product is in early access ahead of launch and free to start on 50 action credits a month; creating, editing and publishing forms uses none of them. AI intake and conversational surveys are paid capabilities. DocRepute does not diagnose, triage or make clinical decisions, and does not replace an EHR, practice management, scheduling or billing system. # Doula Intake Form — Free Birth & Postpartum Template | DocRepute URL: https://docrepute.com/templates/doula-intake-form/ A doula intake form you can edit and download as a PDF, with birth and postpartum modes covering support team, preferences and logistics. Non-medical by design. ## A doula intake form built around support, not diagnosis Birth mode covers preferences, support team and on-call logistics. Postpartum mode covers the household, feeding plans and what help actually looks like. Non-medical throughout, because that is the work. Edit it, download the PDF, no account required. ### 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. ### 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. ## Frequently Asked Questions Q: What is a doula intake form and who uses it? A: A doula intake form is the paperwork a client completes when engaging a doula, covering who they are, who else is involved, what kind of support they want, and the practical logistics of the arrangement. Birth doulas, postpartum doulas and practices offering both use one, usually before or at a first meeting. Q: What information should a doula intake form typically contain? A: Client and contact details; the support team including partner, family, care provider and planned birth location, plus any backup doula; support preferences in the client's own words including comfort measures and anything to avoid; and logistics such as on-call dates, travel distance, parking, other children and pets, and preferred contact method. A postpartum doula intake form adds household composition, feeding plans, sleep arrangements, sibling routines and shift dates. Q: Can this doula intake form be edited before use? A: Yes, completely. Rename it, rewrite any question, change which fields are required, switch between birth and postpartum modes, and add, duplicate, reorder or remove sections. Doulas offering both kinds of support keep one document with a mode switch rather than two files that drift apart. Q: Can I download or print the form as a PDF without signing up? A: Yes. No account, no email wall. A default PDF is available immediately, and after any edit a new PDF is generated from your version so the download matches what you see. It is formatted for US Letter with room to write properly. Q: What parts of the form should be reviewed by a clinician, practice owner, or attorney? A: Your professional body's scope of practice guidance should inform anything you add, since doula support is non-medical and the form should not invite clinical questions. Your attorney should review your client agreement, which covers fees, cancellation and terms and is a separate document from this intake form rather than a paragraph inside it. Q: Does using a template automatically make a practice HIPAA compliant? A: No. DocRepute is HIPAA-focused and built for HIPAA-compliant workflows, but compliance depends on how you store and control access to completed forms. Whether HIPAA applies to an independent doula practice at all depends on your circumstances and is worth confirming, though client confidentiality matters regardless of which rules apply.