Name

Email (this is your email, if it is a gift don't use the recipient's email or they will receive the invoice).

Contact Number

Delivery Address

Would you like the package for a specific date or asap? (I understand that birth is unpredictable so if you don't have a specific date in mind I suggest entering a date approximately 3 weeks past your due date.

Approximately how many weeks postpartum will you be when the package is due?

Are you breastfeeding/planning to breastfeed?

Birth details (i.e. c-section, vaginal, complications you are comfortable sharing with me).

Food allergies/intolerances or just general dislikes.

Do you have any cultural or religious background relating to postpartum which you would like to tell me about?

Do you have other family members at home who you would like included in this package? Typically this package will be created specifically for the Postpartum Mother but if requested I can include a family dinner or a snack for your older children.

Do you have access to a bath at home?

Are you open to giving yourself a simple self-massage (details to be included in the package)?

Are you practicing any kind of belly binding (e.g belly wrapping, Tubigrip, compression shorts ect)?

Is there any physical or mental health history which you would like to share with me?

Any other details (e.g specific requests, current struggles, parenting preferences)?

If this is a gift would you like a message included?

Doula In A Basket Questionnaire

Your answers below will help me to create a package specific to your unique Postpartum Journey. If you are purchasing this as a gift please answer the questions on behalf of the recipient.

Not all fields are required. The more information you can give me the better but if you do not know the answers to most of the questions please don’t be concerned, you will still receive a beautiful package no matter what.