• Ripple Effect - Doula Booking & Medical Form

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  • Please complete the following section:

    If you are pregnant -

    • Number of weeks pregnant
    • Your named midwife.
    • Consultant.
    • Any difficulty with physical exercise, anything you should approach with caution? Please explain.

      General information for all clients:
    • Emergency Contact information - name & telephone number
    • Any other children (if relevant)? If yes, how many?
    • Your occupation?
  • Birth Support Package I

    This contract is between the named client above residing at the address given and Claire Morrow-Goodman (Ripple Effect Yoga).

    Birth Doula:
    I agree to offer 4 antenatal sessions and 1 postnatal visit – where this is not possible the visits will be added to the postnatal period) to the mother-to-be as well as being present as a support during her birth. I agree that my role is supportive and that I will at all times be guided by the mother-to-be’s birth wishes, decisions, and needs, I will not give any medical advice nor do I purport to be a midwife. As part of this contract I will be available for consultations by phone or email from the first to the last visit.

    I agree to be ‘on call’ from 10 days before the clients due date (see above information) until 14 days after clients due date. The client has informed me that her expected due date is as entered above.

    The mother-to-be will be required to pay a fee of £950.00 plus mileage (45p per mile)

    Should the client go into labour before the oncall period has started I will endeavour to be with you as soon as possible.

    During the on call period I will be within half an hours distance. The fee is to cover the antenatal visits, the on call period, attendance at the babies birth and the postnatal visit.
    Should we decide to meet more often than stated above, these extra meetings are not covered by this agreement and incur a fee of £60 per visit (2-3 hours).

    Mother-to-be:
    I wish Claire Morrow-Goodman to support me during my labour and birth.

    I understand and agree that the doula will visit me twice before the birth and once postnatally as well as being present at the birth.

    I agree the fee to be £950.00

    If I cancel this agreement once it has been signed and before the period of being ‘on call’ begins, I agree to pay a cancellation fee of £450.00

    If I cancel after the period of being ‘on call’ has commenced, or I fail to call my doula to be at my birth, I agree to pay the full fee as detailed above (£950.00).

    I understand and agree to pay a mutually agreed fee for extra visits other than the above stated, should I wish to meet the doula more often.

    I understand that this fee is not inclusive of travel costs (fuel costs or public transport costs) or any extras e.g. TENS machine replacement pads (£15.00), homeopathic remedies (£12) and these will be invoiced and are payable by instalments or in full before the birth. The current rate for mileage is £0.45 per mile.

    The decision to employ a doula remains the individuals and the doula cannot accept any responsibility for problems during or after the pregnancy and birth. I understand that I employ the doula at my own risk and that any injury or other mishap will not be the responsibility of the doula.

    A non refundable deposit of £350 has been paid upon signing this agreement or the payment has been received in full (£950.00).

    If the payment has not been paid in full at the time of booking.
    There is an option to pay the remaining balance after the initial deposit by instalments. See below.

    The fee does not include birth pool hire,
    TENS machine and replacement TENS pads, mileage or homeopathic remedies.

    Should any unforeseen circumstances prevent the doula from being able to attend the mother-to-be, the mother to be will be required to pay a fee of £450.00 should unforeseen circumstances prevent me from being present at the birth to cover the antenatal visits, the on call period and the postnatal visit.

    The payments can be made in instalments or paid in full.
    If opting for instalments the payments are due as follows (plus any additional expenses):

    £350.00 Deposit Received
    £150.00 due Week 26
    £150.00 due Week 28
    £150.00 due Week 30
    £150.00 due Week 32
    £additional expenses due at the postnatal visit

    Your post-natal visit is arranged within the first four weeks after the birth of your baby. This visit is to discuss your birth experience, help and assist you in the post-natal period. This visit is approximately 2-4 hours in duration.

    Every client has 12 weeks postnatal support via telephone and email, additional visits can be arranged as required. All additional expenses can be added to the instalments or the full payment.

  • Birth Support Package II - Last Minute - BOOKED WHEN IN LABOUR

    This contract is between the named client above residing at the address given and Claire Morrow-Goodman (Ripple Effect Yoga).

    Birth Doula:
    I agree to be present as a support during the clients birth. I agree that my role is supportive and that I will at all times be guided by the mother-to-be’s birth wishes, decisions, and needs, I will not give any medical advice nor do I purport to be a midwife. As part of this contract I will be available for consultations by phone or email from the first to the last visit.

    I agree to be present with the client when she informs me she is going into hospital.
    The client has informed me that her expected due date is as entered above.

    The mother-to-be will be required to pay a fee of £550.00 plus mileage (45p per mile) or taxi (depending how the doula travels to & from the client).

    Should the client call when in labour and request my support. If I am available I will endeavour to be with you as soon as possible.

    The fee is to cover the attendance at the babies birth.

    Additional appointments not covered by this agreement and incur a fee of £60 per visit (2-3 hours).

    Mother-to-be:
    I wish Claire Morrow-Goodman to support me during my labour and birth.

    I understand and agree that the doula will be present at the birth.

    I agree the fee to be £550.00
    This is paid after the birth of your baby by BACS. If paying by Paypal fees will be added.

    I understand and agree to pay a mutually agreed fee for extra visits other than the above stated, should I wish to meet the doula more often.

    I understand that this fee is not inclusive of travel costs (fuel costs or public transport costs) or any extras e.g. TENS machine replacement pads (£15.00), homeopathic remedies (£12) and these will be invoiced and are payable in full. The current rate for mileage is £0.45 per mile or to pay the taxi fare.

    The decision to employ a doula remains the individuals and the doula cannot accept any responsibility for problems during or after the pregnancy and birth. I understand that I employ the doula at my own risk and that any injury or other mishap will not be the responsibility of the doula.

    Upon signing this agreement the payment will be paid in full after the birth of my baby (£550.00).

    The fee does not include birth pool hire,
    TENS machine and replacement TENS pads, mileage or homeopathic remedies.

    Your post-natal visit is arranged within the first four weeks after the birth of your baby. This visit is to discuss your birth experience, help and assist you in the post-natal period. This visit is approximately 2-4 hours in duration.

    Every client has 12 weeks postnatal support via telephone and email, additional visits can be arranged as required.

  • TERMS & CONDITIONS
    Ripple Effect Yoga pride themselves on offering/promoting excellent courses, professional development and your satisfaction is our prime concern.

    IMPORTANT - Places cannot be confirmed until the full payment has been received and due to small classes it is on a first come first served basis with regards to full payments to be fair on everyone. Any classes / courses / treatments booked must be paid for within 48 hours otherwise they will be re-released.

    All classes, retreats & courses.

    You will receive an email confirmation within 3 days. If you need to contact Ripple Effect Yoga by phone please dial: 07966 288236. Please note that if Ripple Effect Yoga are not available an answer phone will take the call. Please leave your name, number and the details you are enquiring about. This call will be returned with 24hrs.


    PAYMENTS
    If you would like to pay by BACS an invoice using Brightbook will be sent to your email address. Please check your junk folder.
    If paying by Paypal please note that there is an additional charge to cover the Paypal fees.


    CLIENT DECLARATION

    The decision to perform any form of exercise remains the individuals and the teacher cannot accept any responsibility for problems during or outside the class. If you are in doubt as to your or your baby's fitness, consult a GP beforehand.
    I understand that I participate in all yoga classes at my own risk and that any loss, damage, injury or other mishap will not be the responsibility of the teachers. I confirm that I am 14 weeks or more pregnant before the start of the classes.
    With regards to website content & Ripple Effect Yoga branded literature the client agrees to not disclose this to any third party during or after their classes/support from Ripple Effect Yoga. Passwords are also covered by the NDA (Non-Disclosure agreement).

    ONLINE RESOURCES / CLASSES:
    I agree not to record the lesson in any form. Agreement to this Online Teaching Notification will act as my continued agreement to all ensuing on-line sessions, via Zoom or any other video conferencing tool. Ripple Effect Yoga may go live on FB and instagram ... you will be asked if you are comfortable with this and we will be vigilant about not using names etc

    The terms and conditions of Ripple Effect Yoga as outlined apply to the online offerings.

    When you consent "yes" and initial you are in agreement with what is shared on the following link: http://www.rippleeffectyoga.co.uk/privacy-policy-ripple-effect-yoga/ in line with GDPR guidelines (May 2018). *

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