CATHERINE CACHIA FAMILY PHOTOGRAPHY

Birth Intake Form

Please complete the form below

Your Name

First Name

Last Name

Your Phone Number

Country

(###)

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Your Email

Name of Partner/Spouse/Chosen Support Person

First Name

Last Name

Partner's Phone Number

Country

(###)

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Partner's Email

Estimated Due Date

MM

DD

YYYY

Where do you live? (Nearest major intersection)

Where do you plan to give birth? If you are planning a home birth please also list your back-up hospital (if applicable).

Do you consent to the use of flash photography during your birth?

Yes

No

I don't know. Tell me more about this.

As a visual storyteller I follow my creative instincts to the most interesting, beautiful and dynamic places I see. Is there any aspect of giving birth that you have hesitations about me photographing?

What is the most important thing about your birth photos? If you have a vision for what you want the photos to look and feel like, please tell me about it.

Is there anything else you would like to share or think I should know about?