Service Appointment Request Form

Services Inquiry Form

Thank you for your interest in working with Alexis Alsup, Founder of Empowered Doula Services and Curator of the Knoxville Black Maternal Health Conference. Alexis is a dedicated birth worker, student midwife, and passionate maternal health advocate, offering personalized support and education to empower families and communities.
2025 Services Offered

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Please complete this form to inquire about booking the following services:
- Birth Doula Support: Comprehensive physical, emotional, and informational support throughout pregnancy, labor, and postpartum.
- Looking for a Midwife: Interested in home birth and personalized care? Discover midwifery support that centers your voice, values, and vision for birth — right in the comfort of your home.
- Placenta Encapsulation: Professional placenta preparation services to support postpartum recovery.
We look forward to learning more about your needs and will respond promptly.
Contact Information:
Full Name*

First NameLast Name
Phone*

Area CodePhone Number
E-mail*
What days work best for you?*

MondayTuesdayWednesdayThursdayFridaySaturday
What time works best for you?*

MorningAfternoonEvening
Our Offerings:
Service(s) of interest? (select all that apply)*

Birth Doula servicesPlacenta EncapsulationMidwifery Care
If requesting Birth Doula Support:
What's your Estimate Due Date:
Planned Birth Location (e.g., hospital, birth center, home):
Additional Notes or Questions:
If requesting Placenta Encapsulation:
Estimated Due Date:
Planned Delivery Location:
Any Special Preferences or Questions about the process?
Additional Information:
How did you hear about Alexis Alsup or Empowered Doula Services? *
Any other details you'd like us to know:
Acknowledgement Information:

Alexis Alsup is a Certified Birth Doula with extensive experience supporting families. She is also a student midwife and can serve you in the role that best fits your needs — whether as your doula or your primary student midwife under supervision.
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Services Inquiry Form

2025 Services Offered

Contact Information:

Our Offerings:

If requesting Birth Doula Support:

If requesting Placenta Encapsulation:

Additional Information:

Acknowledgement Information: