Client Intake Form

The postpartum period is a time of healing, adjustment, and growth. This intake form helps us learn how to best care for you physically, emotionally, and practically, so you can feel supported, rested, and confident in your postpartum journey.

Your privacy is very important to us. The information you provide in this intake form will be used solely for the purpose of delivering personalized postpartum care and support to you and your family. All information shared will remain confidential and will only be accessed by members of our postpartum support team who are directly involved in your care. We do not sell, share, or distribute your personal information to outside parties unless required by law or with your written consent. We take reasonable steps to protect your information through secure storage and limited access. Please note that while we strive to safeguard your data, electronic communication and online forms may carry inherent risks. By submitting this form, you acknowledge that you understand how your information will be used and consent to it being shared with our postpartum team for the purpose of providing care.

If you have any questions about your privacy or how your information is handled, please contact us directly.