Print a letter to the hospital you will have your baby in the future

If you are planning to have a hospital birth and would like to provide feedback to your hospital about your birth preferences, please fill out the following questionnaire. It should take less than 10 minutes of your time. Once you submit the form, you will be able to preview, edit and print the letter to be signed and mailed to the hospital. (Note: A copy of the letter will be emailed to us for statistical purposes. You will not be on a mailing list or receive spam).

Step 1: Preliminary Information

Fields marked * are required.

First Name *

Last Name *

Address *

Address Line 1

City

State

Zip Code

Hospital *

Expected Delivery Date *

I expect to wear my own clothes instead of a hospital gown during labor and birth

I will prepare a list of preferences (birth plan) for my birth

I would like to be allowed to eat during labor if I am hungry

I plan to use movement and gravity to promote and encourage adequate labor contractions and help the baby descend

I plan to labor in the shower

I hope to be able to labor in a tub at the hospital.

I hope to be able to give birth in a tub at the hospital

I hope to have the services of a midwife at my hospital birth

I'm planning on having an unmedicated birth

I want to have photos taken of my birth by a family member, doula or professional photographer

I'd like the opportunity to initiate laid-back or baby-led newborn feeding techniques on my own, as long as the baby and I are able to do so.

I hope to have skin-to-skin contact with my baby immediately following the birth

I expect to be allowed full rooming in with my baby

Captcha *

What is the fifth letter of the alphabet?

Phone