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Application for Vital Beginnings™ Private Care

Welcome!

Thank you for your interest in Vital Beginnings™ Private Care.

I work with a limited number of women at a time so that I can provide thoughtful, individualized guidance throughout pregnancy and postpartum. This application helps me understand your goals, determine whether this level of support is the right fit, and prepare for our conversation if we move forward together.

Please answer the following questions as thoughtfully as you can. There are no right or wrong answers. I'm simply looking to understand your goals and whether this personalized level of support is the right fit for you.

Start

Question 1 of 10

Where are you in your pregnancy journey?

A

Trying to conceive

B

First Trimester

C

Second Trimester

D

Third Trimester

E

Early Postpartum (0-12 weeks)

F

Later Postpartum (3-12 months)

G

Other

Question 2 of 10

What prompted you to apply for private care today? 

Question 3 of 10

What are you hoping to gain from working together? 

Question 4 of 10

What has been your biggest challenge so far? 

Question 5 of 10

Which areas would you most like support with? 

(Select all that apply)
A

Creating an individualized pregnancy plan

B

Understanding what is happening in my body

C

Making safe, natural pregnancy choices

D

Nutrition & Supplements

E

Lifestyle and stress management

F

Common pregnancy symptoms

G

Provider communication and decision-making

H

Laboratory testing and imaging

I

Birth preparation

J

Healing after birth trauma

K

Pregnancy loss

L

Rainbow baby (pregnancy after loss)

M

Postpartum recovery

N

Breastfeeding and newborn feeding

O

Other

Question 6 of 10

What kinds of providers are on your current care team?

Question 7 of 10

Why does this level of support feel important to you? 

Question 8 of 10

Is there anything else you'd like me to know as I review your application?

Question 9 of 10

What would help you feel most supported during this season of life?

Question 10 of 10

I have reviewed the investment options and understand that this application is the first step in determining whether Vital Beginnings™ Private Care is the right fit for my needs. If we determine that Private Care is the right fit, we'll discuss the most appropriate level of support before any commitment is made.

A

I am ready to explore whether Vital Beginnings™ Private Care is the right fit for me.

Confirm and Submit