Pre-service Questionnaire 

 1. Have you had any complications in previous pregnancies or births? If yes, please provide details.

2. Are you currently receiving prenatal care from a healthcare provider (OB/GYN, midwife, etc.)? If yes, please provide their contact information.

3. Have you been diagnosed with any medical conditions or health issues that may impact your pregnancy or birth? If yes, please provide details.

4. Are you currently taking any medications or supplements? If yes, please list them.

5. Have you had any previous surgeries or medical procedures related to your reproductive system or pregnancy? If yes, please provide details.

6. Have you experienced any pregnancy-related symptoms or discomforts that you would like to discuss further?

7. Are you planning to pursue any specific childbirth class or education programs? If yes, please provide details.

8. Do you have any known allergies or sensitivities to medications, foods, or environmental factors? If yes, please list them.

9. Have you ever been treated for mental health conditions? If yes, please provide details.

10. Are you open to alternative or complementary therapies during pregnancy or birth? If yes, please provide any specific preferences or interests