Birth Photography Questionnaire

I am so honored that you are interested in having me photograph your birth - one of the most intimate experiences a family can have together. To allow me to best support you and be a part of your birth team, please fill out the following form. I look forward to learning more about you and your family. Thank you!

Please complete the form below

Your Name *
Your Name
Your Birthday *
Your Birthday
Your Cell Phone *
Your Cell Phone
Partner's Name *
Partner's Name
Partner's Birthday
Partner's Birthday
Partner's Cell Phone *
Partner's Cell Phone
Address *
What is the best way to reach you? *
When is your due date? *
When is your due date?
Would you be interested in bundling Maternity and/or Newborn Photos in addition to your birth? *
Please include names and roles.
We will discuss this further in person, but just so I have a written record of it, to look back on.
Can I add you to the Self Image Photography Newsletter List? *
I never share your email or personal information. This is just a way to keep in touch!