Birth Questionnaire


Thank you for taking the time to fill out this questionnaire. Your responses will help better understand your unique situation.

Name *
Primary Phone *
Primary Phone
Secondary Phone *
Secondary Phone
Primary Support Person *
Primary Support Person
Support Person's Phone *
Support Person's Phone
What is Your Due Date? *
What is Your Due Date?
Dr. Patty, Dr. Jones & Dr. McSpadden usually allow photography. But double check for your specific case.
Poplar Bluff Regional Medical Center allows both nautral birth and c-section photography.
Address of the hospital/birthing location *
Address of the hospital/birthing location
Births rarely go perfectly according to plan. But please give me as many details as you can about how you expect your child’s birth to take place. (Vaginal/Planned C-Section, Hospital/Birthing Center/Home, Medicated/Natural, Bottle/Breastfeed, Immediate Skin to Skin etc.)
No image containing genitalia will be released publicly (facebook/ website etc) without your consent (and even then, typically cropped to obscure the face so that you’re not identifiable).
How did you hear about Artist By Heart Birth Photography? *
Less than one email per month and no spam.

Thank you for your submission!