Guest Request Form - Birth As We Know It ™️

Full Name

Email**

Phone Number

How many births would you like to share on the podcast?

What was your role in the birth(s) you want to share?

Did you have a partner present during the birth(s) you are sharing? If so, is your partner open to being part of the interview?

Yes

If your partner said yes, in what way would they like to be involved?

Being interviewed together with you on the same day

Doing a mini interview (10-20 mins) of their own on the same day or a different day

Responding to questions via document and I read their responses in the episode (not preferred)

Year of the birth(s) you want to share.

What setting did the birth(s) take place? (select all that apply)(required)

Hospital

Private Birth Center

Home

Other

What country and state did the birth(s) take place?

My time zone is Pacific Standard Time (PST) What is your time zone?

Were there any health concerns during the pregnancy? If yes, please list them below.

Does your birth story include pregnancy loss such as miscarriage or stillbirth?(required)

Yes

Do you have a birth video you would like to share? If yes, please input the URL below.

If you are sharing a birth video, are you open to me using part of the audio (not the video) in part of your episode?

Yes

Please give a brief description of the birth(s).

Are you part of the Birth As We Know It Podcast Community on Facebook? (required)

Yes

No, Not Yet

I just requested to join by going to birthasweknowitpodcast.com/community

How did you hear about the podcast? (required)

Friends/Family/Co-Worker/Word-of-Mouth

Birth Worker/Medical Provider

Google Search

Podcast Search/Streaming Source (Spotify, Apple Podcast, Google Podcast, Etc.)

From Another Podcast (please put the name of podcast in the comment box below)

Social Media (Instagram/Facebook/LinkedIn…etc)

Other

Comments, questions and/or concerns:

**Note that by submitting this Guest Request Form you are also opting in to receive emails about the Birth As We Know It™️ podcast