Wilder Wellness Consulting

Birth Intake

From medical history to the scents and songs that settle you — the fuller the picture, the better I can hold space for your birth. Everything beyond your name and email is optional, and all of it stays private between us.

About you

Full & preferred name

Phone

Partner or co-parent name

Due date

Midwife, OB or care provider

Where you plan to birth

Home, birth center, or hospital.

Medical history

As much or as little as you wish to share.

How this pregnancy has gone so far

Medical history, diagnoses & surgeries

Medications, supplements & herbs

Allergies & sensitivities

Mental & emotional health

Previous pregnancies & births

Your birth

Your hopes & birth preferences

How you imagine coping with intensity

Water, movement, breath, medication — anything you are drawn to.

Fears, worries or past experiences on your mind

Who will be with you

Comfort & preferences

Touch — what you love, what to avoid

Scents you love or cannot stand

Music & sound

Playlists, quiet, affirmations — whatever helps you settle.

Lighting & environment

Postpartum

Feeding plans & questions

Support at home after birth

Anything else I should know

Questions? Email me at wilderwellnessconsulting@gmail.com