Request edit access
📝 Grievance Reporting Form

An ethics claim is an objection lodged against a GBI certified doula or GBI member in which the doula is accused of behavior that violates GBI Standards of Practice and/or Code of Ethics. It may also be against a client receiving any of the GBI services available.

It may be submitted by anyone, including but not limited to the client, their partner or family, a nurse, the client’s care provider, a hospital administrator, another doula, a GBI certified doula, a GBI approved doula trainer; or it may be originated by the Grievance Committee. 

If the objection is determined not to involve possible violations of the GBI Standards of Practice and/or Code of Ethics by a GBI certified doula, GBI member, or client, then it is not an ethics claim. It remains, by definition, a complaint. 

An incident is any potentially negative occurrence arising in a prenatal, birth, or postpartum support situation; involving the GBI certified doula, GBI member as the provider, or a GBI supported client. The incident may be submitted to the Grievance Committee by the doula, client or another party. Please provide as much detail as possible and you will be contacted by a GBI Team Member.

Please complete this form to formally report a grievance, whether it is an ethics claim, complaint, or an incident. All information will be kept confidential to the extent possible, consistent with a thorough and fair investigation.

Upon receipt, the Grievance Review Committee (GRC) will acknowledge the grievance within 5-10 business days.

Sign in to Google to save your progress. Learn more
Complainant Information
Please share your contact information. This information will be kept confidential to the extent possible
Your Full Name *
Phone Number *
Email Address *
Street Address *
Apartment/Suite
City *
State *
ZIP/ Postal Code *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Granny's Girls Birth Initiative.

Does this form look suspicious? Report