The Essentials with a Group Childbirth Class - When Childbirth Class has been Paid (Old Class rate)
Doula Package Service Agreement
Name (as registered at your birth place)
*
First Name
Last Name
Spouse / Partner/ Support Person's Name (or NA if not applicable)
*
First Name
Last Name
Estimated Due Date
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Month
-
Day
Year
Date
Birth Place (Or undecided if you have not chosen yet)
*
Care Provider (Or undecided if you have not chosen yet)
*
Mom's Email
*
example@example.com
Mom's Phone
*
Please enter a valid phone number.
Dad's Email
*
example@example.com
Dad's Phone
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about Debbie's doula service?
*
Debbie Hull is currently orienting new backups for her practice. All doulas she works with are completely trained and qualified. Would you be interested in having an additional doula attend your birth? You set parameters about how involved the additional doula will be (only fetching water and towels or more hands-on involvement) and the doula will be prepared to leave at any point per your wishes. If an additional doula is chosen to attend your birth, you will have the option of meeting her via Zoom prior to your birth. No additional doula will attend without your prior approval.
*
Yes, I am open to having another doula attend my birth.
No, I prefer that only Debbie or her backup attend.
NOTE: Clients booking at or after 35 weeks are required to submit the fee in full. I prefer:
*
to submit only the retainer at this time.
to submit the fee in full at this time.
I prefer:
*
to submit the fee/retainer via Square invoice.
to submit the fee/retainer via PayPal invoice.
to mail a check for the fee/retainer.
My typed name below indicates that I understand that I am to CALL, rather than text or email, my doula if I think I am in labor. My typed name also indicates that I have informed my partner and/or support team about this.
*
Mom's Signature
*
Clear
Dad's Signature
*
Clear
Submit
Should be Empty: