Intake Form Update

You’ve spoken and we’ve listened! It’s been a long time coming but we’ve updated our intake form to include a larger array of gender identities and to take into consideration the many alternative family modules that increasingly exist today. 

There are many reasons to have made these changes, (and to have possibly done so sooner) but we wanted to ensure more clarity, specificity, and inclusivity when filling out intake forms for clients. Over the years, we’ve gotten feedback from providers about the unintentional harm our previous intake form had on the wellbeing of their clients. It is our mission and commitment to serve our customers as they deliver relationship-based care. And we felt that our intake form as we had it, didn’t align with this mission.

We hope we’ve gotten it right, but please feel free to give us feedback as you talk to clients and start to use this feature.

If you’d like send out this new intake form to a client who has previously filled it out or if you'd like to walk through the intake form with current/new clients the video below will walk you through those steps:
If you're here because you'd like to know exactly what has changed, look no further: 

New Look

  • We’ve updated the client Overview screen, so that you’ll see more of the essential client details in the Profile section. 
  • We’ve added dynamic sections pertaining to partner/father of the baby (meaning as clients answer yes/no to certain questions sections will appear/disappear depending on their response).
  • We've moved the "Sexuality" subsection from "Personal Information" to "Lifestyle"

New Questions and Removed Questions 

  • We've added an open text client's pronoun question, which will display below the client's name on the side bar when filled out
  • We’ve added new fertility treatment questions so clients can provide more details on their fertility treatment
  • We’ve added a question in the intake form to capture adults who will have a significant role in the baby's life - names, pronouns, role, and notes may be entered for each person
  • We’ve added “coparent,” “living in the house,” and “on birth certificate” questions to sections about the partner and father of the baby
  • We've added a "gender identity" question with the following options: 
    • Female
    • Male
    • Trans Female
    • Trans Male
    • Gender Non-Conforming
    • Decline to State
    • Other:__________
  • We no longer ask the question: “are you sexually active?”
  • We no longer as the question: "number of current sexual partners?"

New Terminology Pertaining to Clients

  • The sexual orientation options of the intake form have changed to include a broader array of options and the option to “decline to state”
Old Options New Options
Heterosexual Straight/Heterosexual
Homosexual Gay/Lesbian
Bisexual Queer
Other Bisexual
Questioning/Unsure
Other:_________
Decline to State
  • We’ve updated "Sex" options in past pregnancy details for previous children
Old Options
New Options
Male Female
Female Intersex
Atypical
Male

Other:_________
  • In the Client Overview we've changed "Sex" to "Sex Assigned at Birth," and updated the options
Old Options
New Options
Male Female
Female Intersex
Transgender Male
Other Other:_________
  • In the Newborn Physical Exam, we've changed the options for "Sex"
Old Options
New Options
Male Female
Female Intersex
Ambiguous Male

Other:_________

New In-App Terminology

  • “Native language” has been changed to “Preferred language” on the intake form
  • “Family Planning” has been relabeled to “Birth Control History” on the intake form
  • We’ve relabeled “father” to “genetic parent/father”

If you have any questions, concerns, or feedback please reach out to support@maternityneighborhood.com. We'd love to hear from you!