Bereavement Doula Client Intake Form

Our Bereavement Doula Client Intake Form is a thoughtful, easy-to-use tool designed to compassionately gather essential information from individuals and families navigating reproductive loss. Whether supporting a miscarriage, stillbirth, neonatal loss, or termination for medical reasons, this form allows bereavement doulas to understand their clients' emotional, spiritual, and physical needs—offering personalized care and presence during one of life’s most tender and vulnerable times.

Created specifically for bereavement doula work, this form facilitates deep, respectful communication and helps doulas build a framework of support grounded in empathy, trauma-informed care, and nonjudgmental guidance. It is ideal for bereavement doulas, full-spectrum doulas offering loss support, and anyone serving grieving families through reproductive transitions.

Key Features

• Customizable and Easy to Edit: Personalize with your business name, logo, and offerings. Modify sections based on the unique focus of your bereavement support practice.

• Trauma-Informed and Sensitive Design: Gathers vital information gently and respectfully, from health and loss history to spiritual beliefs, memorial preferences, and emotional support needs.

• Supports Informed, Compassionate Care: Helps doulas tailor emotional, physical, and practical care during loss, whether at home, in hospital, or post-loss.

• Encourages Meaningful Communication: Allows clients to express their wishes, boundaries, and needs while establishing a trusting relationship with their doula.

• Printable and Digital-Ready: Available as a printable PDF or digital file for easy distribution, intake, and documentation—whether in-person or virtually.

How It Works

1. Download the Form: Instantly download the Bereavement Doula Client Intake Form after purchase.

2. Personalize It: Open and edit in Microsoft Word, Google Docs, or your preferred editor to add your branding and practice-specific details.

3. Use It with Clients: Share the form digitally or print it for in-person sessions. Use it to guide compassionate intake conversations and create individualized care plans.

Please Note

• For Personal Use Only: This document is licensed for personal use by the purchaser only. It may not be shared, resold, or distributed.

• Digital Product: This is a digital download. No physical item will be shipped.

• No Refunds: Due to the nature of digital products, all sales are final.

This Bereavement Doula Client Intake Form is a valuable tool for providing dignified, compassionate support during reproductive loss. It helps doulas build safety, trust, and connection while honoring the unique grief and healing journey of every family.