Doula Mentor Program

Doula Mentor Program

Please fill in the form below.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Full Name *

Prefix First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Program Details:

2 Hour Orientation:

Overview of program
Mentee expectations
Mentor expectations
Mentor Worksheet

2-4 Client Review:

Overview for each client that you will shadow

2-4 Prenatal Appointments per client:

Attendance at client prenatal appointments
Review of each appointment

2-4 Births:

Attendance during clients labor and birth

Follow up appt after the birth:

Review of day of labor and birth

1 Postpartum appts:

Attendance at 1 postpartum appointment

Fees:

$800 Total

$100 non-refundable deposit due when you sign your agreement. Remaining balance due no later than 1 week prior to orientation.

*1 hour insurance billing workshop if you choose to participate in the Medicaid pilot program. Workshop to be held, immediately after orientation if you qualify. If not the workshop will be held on a seperate day.*

*You may have the option to sign as a contracted Doula with Calming Nature after completion of the mentoring program. Contracted Doulas pay an annual fee of $250.*
When did you complete your training? *
Do you speak any foreign language? If so please list them below.
Where did you complete your training? *
What organization did you complete your training? *
How many births have you attended? *

0 1-3 4 +
Orientation Dates *
Orientation Dates *
Payments can be made via cash, check, or money order to:

Calming Nature Doula Center
By Mail:
223 Grant St.
Buffalo, NY 14213
Memo Line: Mentor Program

You can make your payments by calling us directly or
Cash App: $CalmingNatureDS
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Deposit $ 100.00

Mentor Fee $ 800.00

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

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