Thank you for your interest in newborn and postpartum support. This form helps me learn more about your family, your baby’s needs, and the type of care you’re looking for. Whether you’re seeking overnight newborn care, daytime postpartum support, or a blend of both, the information you share will help me understand how to best support your goals and preferences. I’ll review your responses and be in touch to schedule a time to connect and discuss next steps.
What type of support are you interested in?
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Postpartum Doula
Newborn Care Specialist
Newborn Sleep Support/Overnight Care
Not Sure
Sleep Consulting Only
Please fill out a sleep form instead.
My rates for Newborn Care Specialist (NCS) and Postpartum Doula (PPD) support start at $45CAD ($35 USD) per hour. The rate may vary depending on the location, time of day, number of children, and the level of support needed. Please select the option that best applies to you
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Yes, I understand and would like to move forward with completing this form.
That is outside of my current budget, but I would still like to schedule a short call to learn more and possibly get connected with another provider.
Your Name
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First Name
Last Name
Your Email
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example@example.com
Your Phone Number
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Area Code
Phone Number
Baby's birthday or your due date.
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When would you like support to start?
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Would you like a partner's information added?
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Yes
No
Your Partner's Email
example@example.com
Your Partner's Name
First Name
Last Name
Your Partner's Phone Number
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Area Code
Phone Number
Your Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you are not local to Toronto, do you having housing available? If yes, please elaborate.
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No
I am local to Toronto.
Other
Birth Location
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Hospital & City
Planned Method Of Feeding (I am here to support whatever option is best for you!)
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Breastfeeding
Formula Feeding
Combination
Not sure but I would like more information
Are you currently experiencing any specific health or other concerns that may impact the type of care you or you baby will need?
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Is this your first child
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Yes
No
Please share the ages of your other child(ren) and whether or not they live in the home.
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Have you taken or are you planning on taking newborn parenting classes
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Please share any childcare practices or specifics that are important to you during the first few weeks.
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What type of schedule are you looking for?
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Daytime
Overnights
A mix of days and nights
24/7 Care
Not sure
Approximately how many hours a week do you want support?
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What is your vision for your 4th trimester?
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How did you hear about me?
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Anything else I should know in order to better support you?
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Family dynamics, cultural/religious practices, or specific concerns.
I will only work with families that are committed to following safe sleep practices. I follow both American & Canadian guidelines, whichever are stronger.
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I understand
Submit
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