My philosophy:
My philosophy is that every woman deserves to hold the honor of bringing life to the world and to experience the pleasure of giving birth her way.
About your doula:
As a doula service provider, my aim is to provide you with the tools to self-advocate during pregnancy and labor, be present with an objective & unbiased viewpoint, assist you in making empowered decisions based on reliable, evidence-based facts, ensure your choices and experiences are honored, and help validate your choices and pregnancy outcome, on your terms. I will accompany you in labor, providing emotional support, physical comfort, and if necessary, communicate with the medical staff present to make sure you have all the information you need to make informed decisions. I want to get to know you and your birth companion(s) prenatally, and will continuously support you and your loved ones during and after the birth. As your doula, I work for you directly, not for your caregiver or hospital. My job as your doula is to be completely present for your birth experience, physically, emotionally and energetically.
Birth of a Dream: Birth & Postpartum Doula Services Information Form
Please provide the most accurate responses to the following
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
Weeks of gestation:
35 or less
35-37
37
37 or more
I plan to have a _____________ birth.
Please Select
Natural home with Midwife
Natural hospital
Medicated hospital
Natural birthing center
Medicated birthing center
Other
I plan to give birth SPECIFICALLY at __________________.
If no birthing place has been chosen yet, please leave blank.
Birthing Partner Information
In this section you will provide the information for the person who will be assisting you in birth.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Qualities you need from your doula:
Empathy
Enthusiasm
Knowledge
Assertiveness
Humor
Seriousness
What other attributes are you looking for in a doula?
Extra services request: (fees will be added into contract)
Prenatal massages
Prenatal yoga
Essential oils
Lotus birth
Baby shower planning(decor)
Affirmation poster
Extra pre-natal visit (more than 3)
Extra postpartum visit
How did you hear about me?
*
Please Select
Newspaper
Internet
Magazine
Other (Please specify...)
Other
*
Please provide any other information below that you would like me to know about your pregnancy or birthing expectations:
Submit
Should be Empty: