Join the Doulala Pilot Program!
We’re excited to support you during your pregnancy journey! All information you provide is kept strictly confidential and is only used internally to help us understand how to best support your unique needs. Your privacy and trust are important to us.
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Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What city do you live in?
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Please provide an emergency contact name and phone number.
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Please indicate your current stage of pregnancy or postpartum?
*
Please Select
First trimester (1-13 weeks)
Second trimester (14-27 weeks)
3rd trimester (28 weeks to birth)
My birth is planned soon
Recently postpartum (0-6 weeks post birth)
Extended postpartum (6 weeks to 1 year post birth)
Beyond 1 year postpartum
Other
How confident are you in your knowledge about your current stage of pregnancy and what's ahead?
*
Not confident at all
1
2
3
4
Very confident
5
1 is Not confident at all , 5 is Very confident
What is your current level of stress or anxiety related to pregnancy?
*
None at all
1
2
3
4
Extremely stressed
5
1 is None at all, 5 is Extremely stressed
What type(s) of support are you most interested in? Select all that apply.
*
Birth preparation: Guidance on creating birth plans, understanding labor stages, and setting expectations.
Labor support: Emotional and physical support during active labor, including comfort measures and encouragement.port
Prenatal Care Support: Regular check-ins and education throughout pregnancy to promote health and wellbeing.
Postpartum Support: Assistance with recovery, newborn care, and emotional adjustment after birth.
Lactation Support: Help with breastfeeding techniques, troubleshooting, and building confidence.
High-Risk Pregnancy Support: Specialized guidance and emotional support for pregnancies with medical complications.
Emotional Support: Continuous empathetic listening and reassurance throughout pregnancy and postpartum.
Other
What kind of personality traits are you looking for in a doula? (E.g. introverted/extroverted, nurturing vs. clinical tone, etc.)
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Which are you most interested in?
*
One-on-one doula sessions
Group office hours
Both
What day(s) and time(s) during the week work best for you to attend group office hour sessions?
*
How frequently would you like to meet one-on-one with a doula?
*
Weekly
Bi-weekly
Monthly
Not sure yet
I'm not interested in one-on-one sessions
Other
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Doulala Pilot Program Registration Fee
This one-time fee covers access to all office hours sessions throughout the duration of the pilot.
$
50.00
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