Birth Debriefing Services: Journey to Clarity

Tania Fragoso

Perinatal Counsellor & Coach

90 Minutes

Personal Information

First Name

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Last Name

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Questions / Comments

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Time Zone

Additional Information

Basic Information

Full Name

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Date of Birth:

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Location: (Address, Postcode, and City)

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Contact Details: (Phone and Email)

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Wellbeing & Support History

Previous Support: Have you worked with a coach, psychologist, or therapist before?

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Current Situation: Do you have any current diagnosis that I should be made aware of, and are you currently receiving support for this.

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Our Work Together

The birth you'd like to debrief — when it was, where, and the broad shape of what happened (as much or as little as you want to write now).

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Have you shared, or will you share, your birth notes?

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What are you hoping to find some peace with?

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Additional Space: Is there anything else you’d like me to know before we begin?

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Neuro-Affirming & Communication Preferences

Sensory Needs: Do you have any sensory preferences for our sessions (e.g., preference for camera on/off, specific lighting, or being able to move/fidget while we talk)?

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Communication Style: How do you process information best? (e.g., "I need time to think before answering," "I prefer written summaries after calls," or "I like direct, clear feedback.")

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Executive Function Support: Is there anything I can do to make our sessions more accessible for you (e.g., sending a reminder 15 minutes before, or keeping a shared digital list of our "next steps")?

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Energy Levels: Are there specific times of day when your "brain fog" or fatigue (if applicable) is most manageable?

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Trigger Awareness: Is there anything specific regarding birth language or certain topics that you find particularly overwhelming or would like me to approach with extra care?

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Emergency & Crisis Support

Emergency Contact Name:

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Relationship to you:

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Emergency Contact Telephone:

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Your Local Emergency Services: (e.g., 112 in Spain/Europe, 999 in the UK)

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GP or Local Medical Practice Name & Number:

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Safety Agreement: "In the event of a mental health crisis or if I become concerned for your immediate safety during our online session, I have your permission to contact the individual listed above or local emergency services. Do you agree to this?

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