I know that this is not going to be exceedingly helpful...but forget the checkbox form. Do your darndest to keep it down to one page. Staff is more likely to actually LOOK at it the shorter and sweeter it is. Forget the stuff that you can simply control yourself, like the lights being low, or wanting to use music, not wanting to wear a hospital gown. Say no thank you to the gown, turn the lights off or down when you get there, and plug in your i-pod or CD player. Make important the things that you don't want to have to dicker about while in labor...like not wanting to have an IV, not wanting to be yelled at as a form of encouragement for pushing, waiting to clamp and cut the cord till the placenta is birthed, whatever is non-negotiable for you...write THAT down.