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Doula booking application & contract

A simple order form template with quantity, color and size options. Ideal for preparing an order form in seconds.
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    We have supported multiple women to achieve their Vaginal Birth after previous Caesarean births, both in hospital and at home.
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    This helps me to know if what you're looking for is in alignment with what I can provide you, through our meet and greet it will become clear if we are a fit and can proceeds, alternatively I may be able to refer you to another service provider.
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    You can add further packages at a later date.
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    Agreement Terms:

    • Payment must be made in FULL at the time of booking OR 2 half payments can be made; half the total fees paid when booking in and the remainder of the fees paid 1 MONTH prior to your Estimated Due Date.
    • The purpose of this Agreement is to ensure that there are no misunderstandings between the doula and client. It also sets clear boundaries and expectations for both parties.


      1. What is a doula?

      A doula is NOT a Doctor or Midwife and has no clinical responsibility or role in your birth. However, a doula can positively impact the birth experience for the mother and baby in many ways. As a doula, I support women before, during and after labour by providing personal assistance. I draw on my experience and knowledge to give you emotional support and physical comfort throughout the birth. I also provide you with as much information as I have on topics surrounding childbirth so that you can base your decisions and your birthing plan on a variety of information. The information I have comes from published books, articles and DVDs, and my personal experience, which I can loan to you or direct you to find. Throughout your pregnancy, birth and the postnatal period I am employed by you, not the hospital and I dedicate myself only to your needs. I make myself available to provide reassurance to you and your partner, to discuss all options available to you, and to help you relax and find your most comfortable positions during labour. I will not give you advice or make decisions for you, but I will endeavour to get unbiased information to you so that you can make your own, informed decisions.


      2. Limitations:

      A doula has no clinical responsibility and hence does not undertake any bio-medical observations:

      • DOES NOT listen to the foetal heart

      • DOES NOT take blood pressure measurements

      • DOES NOT take the client’s temperature

      • DOES NOT do vaginal exams

      • DOES NOT give advice or prescribe treatment


      3. Initial meeting:

      In order for you to decide if I am the right doula for you, I offer a complimentary and obligation-free initial meeting (30 mins). At this meeting we can discuss what you are looking for in a doula, my fees, terms and conditions and your situation.


      4. Moving forward:

      If you choose me as your doula, the next steps are:

      □ 

       

      Discuss and sign agreement

      □ 50% non-refundable retainer fee to secure your position

       

      Payment details:

      BSB: 064171

      A/c: 10398148

      Name: Tessa Bobir

      Refernce: Your name.


      5. My services:

      My Pregnancy & Birth package includes 3 prenatal visits (3 hours each), unlimited phone/email support, access to my resource library, on-call from 37 weeks, birth attendance, 3 postnatal visits (3 hours each)  with 1 Meal and snacks at included in every post natal visit (3) $3250.00

       

      My Postnatal ONLY Package includes 3x 3 hour postnatal visits $414.00

       

            My Post natal WITH Meals package 3x3 hour postnatal visits + 1 main meal and snacks per visit included $616.00

     

    • 6. Contacting me:

      Should you wish to talk about anything related to the birth, you are welcome to email or text me at any time.  You can call me between the hours of 9am-5pm, Mon-Sat.  If you would like to speak to me for an extended period of time, it is preferable if you could send me a text so that I can return your call at a convenient time.  During the on-call period, you can call me at any time during the day or night on any day! My details are: 0423398186, tessa.bobir@yahoo.com


      7. Prenatal visits & support:

      During our visits we will get to know each other, discuss your birth plan/map and how you would like your support people to work together and with you during the birth.  If you feel you need additional visits or support at an appointment with your care provider, please let me know.


      8. On-call period:

      I will be on-call from 37 weeks until the birth.  I will have my phone with me at all times.  I may have other commitments during this period but will have plans in place, should your birthing time begin and you require my presence.  Please keep me updated with how you are feeling and any signs that the birth may be imminent.  This is important as I require time to arrange childcare for my children. I will endeavour to get to you as soon as possible but it may take up to 90 minutes.  If you do not want me to come straight away, it would be helpful if you could update me every 2 hours or so. If labour begins before 37 weeks, I will do everything I can to be there.


      9. The birth:

      I will meet you at the hospital or at your home. If you want me to support you in labour at home you must understand that I have NO CLINICAL RESPONSIBILITY and cannot advise you as to when you should go to the hospital.  This is your choice and if in doubt, you should contact your care provider. I am there to support you and take my direction from you. When transferring to the hospital, I will travel in my own car and meet you there.  I will stay with you throughout the birth process unless extraordinary circumstances intervene.


      10. Precipitous birth:

      In some circumstances, labour progresses more quickly than anticipated. If your baby arrives unexpectedly at home with me present, you or your partner will be responsible for the birth of your baby.  I will obviously help in any way I can but it is very important that you communicate directly with your care provider and take your direction from them.  I am not responsible for the birth of your baby or performing any clinical skills related to the birth of your baby.  


      11. Unforeseeable circumstances:

      If for any reason you are unable to contact me, or due to unforeseeable circumstances eg A natural disater, and I cannot be with you for the birth, a partial refund will be given less the hours already provided, and to be provided during postnatal care ( if this package was the booked packaged)


      12. Changing your mind:

      It is completely up to you WHEN and IF you want me to attend you during your birthing time. If you feel you are coping well and/or no longer need/want me there that is completely fine.  Please send me a text to let me know.  I will still be ready to come if you change your mind again but this will help me to plan my day.  There is no refund for changing your mind.


      13. After the birth:

      I usually stay with you for around 2 hours, unless you are comfortable and you wish to be alone with your family. I like to meet with you within a week of the birth to review the birth and provide breastfeeding support.  If you would like additional postnatal visits, please let me know.


      14. Mutual respect:

      The doula-client relationship is based on mutual respect.  This includes honest, open and non-violent communication.  I will do everything I can to honour our relationship. I reserve the right to withdraw my services if I feel that I am being misled or mistreated (see Clause 15 below).


      15. Payment terms & refund policy:

      1. To reserve your place, I require 50% of the invoiced amount paid up front, with the balance paid no later than 34 weeks.

      2. If fees have not been finalised, I cannot go on call at 37 weeks.

      3. I restrict the number of births I attend to ensure that I am available without conflict to my clients. This means that I may turn away clients to avoid conflict with existing clients. Because of this there are limits on refunds. I will only refund 50% of the invoiced fees if you cancel before 34 weeks. There will be no refunds after 34 weeks, the full fee is payable. This compensates me for time spent with you as well as the loss of opportunity to work with other clients.


      4. I will do everything within my power to be available for your birth. In the unlikely event that:

      (a) I am unable to attend your birth;

      (b) I am delayed (i.e. more than 90 minutes after you request me to come) and arrive after the baby has been born; or

      (c) I have to leave early due to a family emergency 

      I will refund a portion of your fees. 

      If I do not attend at all, I will provide a 50% refund of the total invoiced amount.  For all other circumstances, I will give a 50% refund less the cost of services provided at an hourly rate of $77.00


      5. If I arrive within 90 minutes of you requesting me to come and you have already had the baby, if you do not call me to notify me to come, or you change your mind, there is no discount or refund.


      6. My support at your birth is unlimited; however, it is necessary to exercise common sense with this.  On the rare occasion of a birth going for an extremely long time it may be necessary for me to leave to arrange further childcare, attend to my family or to get some rest.  In this instance, I will communicate openly with you about the situation and ask for your understanding.  I may be able to arrange my back-up doula to fill in for me (there is no extra charge for this).


      7. In the case of a planned caesarean section, I can still provide support at the hospital before, during and after the birth.  Refunds are only given in exceptional circumstances.

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    This helps me to reach other families seeking support and care.
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