Postpartum Doula Contract

Name:*

First NameLast Name

Phone Number:*

Please enter a valid phone number.

Email:*

example@example.com

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Estimated Due Date:*

Date

Client Responsibilities

Communicate honestly about any applicable medical or emotional health conditions.
Inform me on the arrival of your baby within 24 hours after birth.

*The role of a postpartum doula is not that of a primary childcare provider. A parent must be at the home at all times while the postpartum doula is working.

Package options:

Starter (8 hours, deposit $200)Additional hourly support at $20/hr *select when you know you want more that 8 hours of support

Disclaimer:

Doulas are not doctors or midwives and do not practice medicine, nor diagnose and treat postpartum related symptoms. Information presented in our meetings and conversations is not intended as a substitute for the medical advice of a properly licensed health care professional. In addition, doulas do not make specific health claims or promise medical results. We provide education, guidance, and postpartum and breastfeeding support.

A postpartum doula does not dispense any medications (over the counter or prescribed) to any member of the family or diagnose any medical conditions in mother or baby. She is also not responsible for major household cleaning tasks, nor will she take over care of the baby, discipline other children, or transport any member of the client's family.

*An initial deposit of $200 is due upon signing this contract and serves as a retainer for putting your due date on my calendar. This payment is non-refundable. Postpartum doula package fees are a payment plan for contracted hours and are not itemized, thus upon contract signing, you agree to the contract in full. Refunds are not provided for any unused portion of the contract and payments are non-transferable.

If your postpartum doula cannot work the agreed hours on any given shift, you will be informed as soon as possible and you will be given the option to reschedule those hours. She will provide a qualified backup (if available, due to circumstances back up may not be available short notice) and is responsible for the payment of back up support. The backup postpartum doula will provide the same services outlined in this contract.

By signing this contract, you agree that I have discussed all the points herin and you understand and agree with them.

Signature

Date

Notes:

Postpartum Offering

Starter Bundle8 hours, additional hours added at $20/hr no hour minimum

$200.00

Total

$0.00