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Doula Support Intake

Thank you so much for your interest in my doula support services!
It’s a true privilege to walk alongside families during such a powerful and transformative time. Whether you’re seeking emotional support, physical comfort, or informed guidance, I’m here to help you feel empowered and cared for every step of the way. Please don’t hesitate to reach out with any questions or to explore how I can best support you.

Please review the terms below and complete the form at your convenience.   

Prenatal/Labor/Postpartum Services Description: A support person is a professional birth worker who offers evidence-based and non-medical support to the pregnant person and the partner/support person. A support person is not a medical professional and does not give medical advice or administer any medical procedure.

Limitation
The client is responsible for informing the support person as soon as you think you are in labor, even if you are unsure.  The support person will make every effort to be available for the client. Should there be a circumstance when the support person and her backup are not available, the initial payment will be kept, but any other fees made will be refunded.

The support person will typically arrive at the designated location (labor support at home upon approval of your care provider) within two hours of activation of the service by the client.

In the event of rapid labor or emergency, I will call 911. In the event of an emergency delivery, I will do what measures I can to try to keep you and the baby safe and comfortable until EMS arrives. This will fall under The Good Samaritan Law.  I will remain with you throughout labor and birth except for extraordinary circumstances. 

Liability waiver
The client understands that the support person has a limited role pursuant to the description of tasks outlined in the above-referenced contract wherever services are provided to me/us.

Now, therefore, in consideration of the above acknowledgments, the client (both jointly and separately) on behalf of themselves, heirs, administrators, personal representatives, and executors, do release and forever discharge Birthworks Baltimore, LLC from all damages or causes of action, either at law or in equity, as a result of using the services Birthworks Baltimore, LLC and Kristie Graybill.

The client intends this to be a complete release and discharge of Birthworks Baltimore, LLC and Kristie Graybill from all liability whatsoever.  The client has read all statements contained herein, and you fully realize that you are signing a complete release and bar to any claim which you have or believe you may have to result - from- our contract for support services. 

Availability: I only take 5 births annually. I will review your intake form and then decide on if this feels like an aligned match. 

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Your Email
Your Name *
Is this your first pregnancy? Please give as much or as little information as you feel comfortable.  *
Estimated Due Date? *
What is your cell phone number? *
What is your home address, including zip? *
What is your partner's name?
Where will you be delivering?  *
How did you hear about my services? Did someone refer you? *
Are you also interested in other services such as childbirth education or placenta encapsulation? *
Required
Why are you considering a doula? And what are your expectations of this type of labor support? *
What is your ideal birth vision? How do you believe I would fit into that vision? *
Is there anything else you want me to know about your family, home or pregnancy? *
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