Birth Doula Contract

Page 1 of 3 - Contact Information and History

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Client Name Client Name First Last
Partner Name (If Applicable) Partner Name (If Applicable) First Last
Estimated Due Date Estimated Due Date / MM / DD YYYY
My Doula is

Fee listed is your doula's full fee. You will have the option to pay a 50% deposit below.
Midwife or Doctor
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Partner's Phone Partner's Phone - ### - ### ####
What pregnancy is this for you?
How many births have you had?
How many children do you have?
Please mention any pregnancy complications, past surgeries and concerns.
Are you a survivor? A victim of sexual abuse or violence?

You are not to blame. We will not ask any details. Labor and birth may be triggering for women. We can best support you if you share with us any triggers you may have and can help you find support.
Do you have any history of anxiety, depression, or other mental health concerns?
Have you taken an out of hospital childbirth class?

We recommend all our clients take an out of hospital childbirth class. We offer many class options to help you. Classes are fun and full of great info!
How do you plan to feed your baby?
Custom Packages
We understand that preparing for your birth, baby and postpartum can feel like a lot. Think of us as you would your wedding planner. We are here to support you in all the things we can, and if there is anything else you need, please let us know. It is our goal for you to feel cared for and loved throughout your pregnancy, birth and postpartum.

We understand that preparing for your birth, baby and postpartum can feel like a lot. Think of us as you would your wedding planner. We are here to support you in all the things we can, and if there is anything else you need, please let us know. It is our goal for you to feel cared for and loved throughout your pregnancy, birth and postpartum. Prepared Feeding - An online 2.5 hour breastfeeding and infant feeding course with Nola Nesting and Breastfed Nola founder, Amanda Devereux, RN IBCLC. You will have access for one year and can return to watch segments whenever you like. $40 Prenatal Infant Feeding and Postpartum lactation consultation - whether you are preparing to breastfeed or formula feed you will be ready! This is a one hour appointment with an IBCLC lactation consultant during your pregnancy and a one hour appointment after birth. $200 Childbirth Education - Choose the course that's best for you. We offer a comprehensive 6 week course, a weekend course, and private courses (up to a 5 hour private session) $300 Placenta Encapsulation - encapsulate your placenta to help support you postpartum. $250 New Orleans Moms Club - Join us every wednesday at 10:30 for mom to mom support. Open to everyone who has ever had a baby. Because we are always postpartum. FREE
$0

Total

+Tax 3%

Birth Doula Contract

Birth Doula Contract

Page 1 of 3 - Contact Information and History

Custom Packages

$0

Total

+Tax 3%

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