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Birth Client Intake Form

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Please note that some of these questions involve sensitive subjects. If you are able, fill this out somewhere peaceful. Take your time. Other than required contact info, you may fill this in as much or as little is supportive and helpful to you.

If you’d like help or guidance filling this out, I am happy to hop on a call and walk through it together. This form is an opening for further conversation, not a definitive list of answers.