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  • Birth Doula Services Referral Form

    A Collaboration Between Bx (Re)Birth and the Citywide Doula Initiative

  • Eligibility --

    To enroll, you must meet both of these requirements: 1. Live in one of the following zip codes:   Bronx: 10451, 10452, 10453, 10454, 10455, 10456, 10457, 10458, 10459, 10460, 10463, 10466, 10467, 10468, 10472, 10473, 10474 Queens: 11101, 11368, 11369, 11412, 11419, 11420, 11421, 11423, 11429, 11432, 11433, 11434, 11435, 11436, 11691, 11692, 11693, 11694 Brooklyn: 11205, 11206, 11216, 11221, 11233, 11238, 11206, 11207, 11221, 11237,11207, 11208, 11239, 11220, 11232, 11224, 11235, 11226, 11212, 11233, 11203, 11226,11236 Manhattan: 10002, 10003, 10009, 10013, 10025, 10027, 10031, 10032, 10026, 10027,10030, 10037, 10039, 10029, 10035, 10032, 10033, 10034, 10040 Staten Island: 10301, 10303, 10304, 10310 OR live in a shelter OR foster home anywhere in NYC OR be 19 years old or younger 2. Be income-eligible for Medicaid

  • You do not meet eligibility requirements to receive services through the NYC Citywide Doula Initiative (CDI) program. 

     

    You can request no-cost doula services through one of the organizations listed below. Click on the link(s) to submit a referral form. 

    Caribbean Women's Health Association (Brooklyn, Bronx, Manhattan, Queens and Staten Island residents)

    Ancient Song Doula Services (Brooklyn, Bronx, Manhattan, Queens and Staten Island residents)

    Bx (Re)Birth and Progress Collective (priority given to Bronx residents)

    Maternal Birth (Brooklyn residents)

    Brooklyn Perinatal Network (Brooklyn residents) - call 718.643.8258 or email RCollins@BPNetwork.org

     

    Thank you, and best wishes!

  • Responses to the questions below should pertain to the person requesting doula services only.

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  • By saying yes, you agree to share your information with a group of trusted health and community partners who work together using the Unite Us system. These partners help you get the care, services, and support you need.Your information will be shared safely and only with people or organizations that are helping you or paying for your care. We follow all privacy laws to protect your personal information.This permission includes information you share yourself, or that someone you’ve allowed to speak for you shares, as long as it helps connect you to services. You can ask to limit or remove your information from the network at any time.To learn more about how your information is used and protected, visit: uniteus.com/privacy-policyIf you ever decide you don’t want your information shared anymore, you can email consent@uniteus.com or tell any partner in the Unite Us Network.

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