Happy Birth with AnnaDoula · Anna Pifko RU Free consultation

New client form

Tell me about you

For families who have booked a consultation or paid their deposit. Your answers give me the background I need to support you safely. It takes about ten minutes.

Questions marked * are needed.

About you

Relationship status

Your partner

If you have a partner who will be involved. Leave blank if not.

Emergency contact

Someone I can reach if I cannot reach you, for example while you are in labour.

Your midwife or doctor

Who is looking after your pregnancy?
Do they know you are planning to have a doula?
Where are you planning to give birth?

Previous pregnancies

Is this your first pregnancy?

Anything else

Your information

Anna Pifko, trading as Happy Birth with Anna, is responsible for the information you give in this form (the data controller under UK GDPR).

I use it only to prepare for and provide your doula support, and to contact you or your emergency contact if I need to. It is stored securely and is not shared with anyone else or used for marketing.

If we do not go on to work together, I delete it within 12 months. If we do, I keep it for the periods set out in my privacy notice.

You can ask to see, correct or delete your information at any time by writing to anna@happybirth-doula.co.uk.

Read the full privacy notice →