Dad Doula Client Referral

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The mission of DAD DOULA is to provide resources, and guidance for the THE NON BIRTHING PARENT as they plan to support THE BIRTHING PERSON DURING PREGNANCY, LABOR AND DELIVERY AND THEREAFTER. This is done by learning how to advocate, and support with intentional presence. This service is extended to expecting parents, new again parents and parents looking to reenter their children's lives.

Email *

Record my email address with my response

First Name, Last Name *

Address *

City *

State *

Zipcode *

Expected Due Date *

YYYY

Are you a... *

Brand New Parent (expecting 1st child)

New Again Parent ( already have children)

Returning Parent ( have been historically absent from child

Planning Parent ( don't have children, yet)

Email Address

Cell Phone Number

What is your relationship with the Birthing parent. *

Married

In a relationship

No longer together

Estranged

Other:

If you represent an organization please write the name of the organization below. *

I understand that 1. Dad Doula is not a medical professional and can not give out medical advice. 2 I understand that I need to click the submit button for my Dad Doula Inquiry form to be received. 3. I must select "send money to family or friends" if paying with PayPal otherwise my full payment will bot recognized and I will be asked to pay additional fees. 4. I need to type my name in the notes section of desired payment platform so Dad Doula can match your payment for records.

Yes

There is a sliding fee scale for services for those living outside of Milwaukee, Wisconsin.

I understand

Photo and Media Release

At Dad Doula University, we honor the stories and experiences of every father/Non Birthing parent we serve. From time to time, we capture photos or videos during sessions, events, or community gatherings to celebrate and share the power of fatherhood.

Media Release Consent

I hereby grant Dad Doula University the right and permission to use photographs, video recordings, or digital images of me (and/or my child(ren), if applicable) for the purposes of marketing, education, social media, and promotional materials, including but not limited to brochures, websites, newsletters, and social media platforms.

I understand that:

• My participation is voluntary and I may decline to be photographed or recorded at any time.

• No compensation will be provided for the use of these images.

• Life Redefined MKE will never share personal or identifying information without my explicit permission.

• I may revoke this consent at any time by submitting a written request.

I give my permission to be Photographed/Recorded

Yes, I give permission to be photographed/recorded.

No, I do not give permission to be photographed/recorded.

Clear selection

Send me a copy of my responses.

Submit

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