1. Purpose of Services
I understand that the purpose of postpartum doula services is to provide non‑clinical education, guidance, and support during the postpartum period.
Services may include:
- Postpartum doula visits
- Newborn‑care education
- Feeding and lactation support
- Emotional support and adjustment‑to‑parenthood guidance
- Education on baby cues, soothing, and safe care practices
- Postpartum recovery education
- Support for building healthy parent–infant attachment
- Prenatal or postpartum education sessions included in the package
These services are educational and supportive in nature and do not replace medical, nursing, or mental‑health treatment.
2. Scope of Practice
I understand that the doula does not:
- Provide medical or nursing care
- Perform clinical assessments
- Diagnose or treat medical conditions
- Provide psychotherapy or clinical mental‑health services
- Administer medications or medical procedures
- Make medical decisions on my behalf
The doula may offer non‑clinical education on postpartum recovery, emotional adjustment, and contraception options, and may refer me to appropriate healthcare providers when needed.
3. Service Structure
I understand that services are provided as a package, virtually and in-person, which may include:
- Prenatal education
- Postpartum doula support (within 6 weeks postpartum)
- Newborn‑care teaching
- Feeding and lactation support
- Emotional and adjustment support
- Attachment‑building guidance
- Additional educational sessions as outlined in the service description
The number of hours and schedule of visits will be mutually agreed upon.
4. Fees & Payment
I understand that:
- Fees for services are outlined in the service package description.
- Weekly postpartum service fees are payable in advance, before the first day of each service week.
- All payments are made directly to Parents’ Coach Network. An invoice will be provided for insurance reimbursement, if applicable.
- Reimbursement is determined solely by my insurance benefits plan. I agree that payment for services remains my responsibility, independent of reimbursement outcome.
- A $3,000 deposit is required to reserve a spot for perinatal services exclusively for my family. If services continue as planned, the $3,000 deposit will be used to cover the last weeks of postpartum support at the agreed rate of $70 per hour.
Deposit Refund Policy
The $3,000 deposit reserves perinatal services exclusively for my family. If I choose to cancel services, I understand that deposit refunds are determined by the number of days before the estimated due date (EDD*) that written notice of cancellation is received:
- 90 days or more before EDD: $3,000 refund
- 60–89 days before EDD: $2,000 refund
- 30–59 days before EDD: $1,000 refund
- Fewer than 30 days before EDD: No refund
I understand that the deposit becomes fully non‑refundable within 30 days of the estimated due date.
*EDD (Estimated Due Date)
Refund timelines are based on the Estimated Due Date (EDD) listed in this agreement at the time of signing. If the EDD changes later, the original EDD in this agreement will continue to be used for all refund calculations.
5. Communication & Boundaries
I understand that:
- Services are not emergency, medical, psychiatric, or hospital-based care.
- Emergency or urgent medical concerns will be directed to my healthcare provider or emergency services.
6. Authorization to Communicate with Health Care Providers
I authorize Parents Coach Network to communicate with my health care providers, including but not limited to physicians, hospitals, and allied health care professionals, for the purpose of supporting my care, and continuity of services.
7. Consent to Share Personal & Health Information (PHIPA)
I consent to the collection, use, and disclosure of my personal and personal health information by Parents Coach Network in accordance with Ontario’s Personal Health Information Protection Act (PHIPA) and other applicable privacy laws for the purposes of:
- providing care
- coordinating services
- communicating with my health care providers
- clinical documentation and record keeping
8. Consent to Internal Team Sharing
I consent to the sharing of my personal and health information within the Parents Coach Network care team, including Registered Nurses, psychotherapists, educators, and authorized staff, when necessary to support my care.
9. Limits of Confidentiality
I understand that all personal information shared will remain confidential. My information will not be shared outside of Parents' Coach Network without my consent, except where disclosure is required by law or necessary for safety.
10. Consent to Services
By signing below, I confirm that:
- I have read and understood this consent form.
- I understand the nature and scope of postpartum doula services.
- I understand these services are supportive and educational, not clinical.
- I agree to receive services as described.