Guest Request Form

Hello! Thank you for showing interest in sharing your birth story or experience with me on the Birth As We Know It™️ podcast. I am truly looking forward to reviewing your request and connecting with you.

Name(required)

Email**(required)

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

What was your role in the birth(s) you are wanting to share? (required)

Year of the birth(s) you are wanting 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?(required)

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

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

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

Yes

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

How did you hear about the podcast? (required)

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

Birth Worker/Medical Provider

Google

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

Social Media (Instagram/Facebook/LinkedIn…etc)

Other

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

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