Tarrant County Community Doula Program

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Our Community Doula Program is a grant-funded program that provides no-cost doula support to families residing in Tarrant County. Our team consists of birth and postpartum doulas who will support families throughout pregnancy, birth, and postpartum.

Support Includes:

Prenatal Sessions
Home Visitation
Labor & Birth Support
Postpartum Support
Virtual Consultations

To enroll in services, eligible parents must live in Tarrant County and have an estimated due date between January 2024 and December 2024. Families who live in 76104, or delivering at a hospital or birth center in 76104, will be prioritized for in-person support. We are happy to extend virtual support to families outside of that designated area dependent upon doula availability.

Parents seeking solely postpartum care must be within one year postpartum to be eligible for services.

Disclaimer: monthly availability varies, as each doula can only take a limited number of clients per month.

The Community Doula Program is part of the Tarrant County Maternal Health Initiative made possible in collaboration with United Way of Tarrant County and funds received through the American Rescue Plan Act(ARPA) by Tarrant County.

Email *

Client First and Last Name *

Preferred Name and Pronouns *

Client Date of Birth *

YYYY

Phone Number *

Street Address *

Apartment/Suite Number; write N/A if not applicable *

City, State, and Zip Code *

Race/Ethnicity *

American Indian/Alaskan Native

Asian

Black/African American

Hispanic or Latino/a/x

Native Hawaiian/Other Pacific Islander

White

Other: Please describe below

Required

Please describe if other; write N/A if not applicable.
*

Gender *

Female

Non-Binary

Transgender

Other: Please describe below

Required

Please describe if other; write N/A if not applicable.
*

Please provide your insurance information, if any (i.e, Medicaid, BCBS, Aetna, uninsured) *

Which services are you seeking? *

Pregnancy and Birth Support

Postpartum Support

Required

Estimated Due Date; if postpartum, please state date of delivery *

YYYY

How many weeks pregnant are you? If postpartum, how many days/weeks postpartum are you? *

Expected Place of Delivery. If postpartum, please state where you delivered. *

Hospital

Birth Center

Home

Please state the name of the facility where you are expecting to deliver, or already delivered. (Ex: JPS, Texas Health) *

Is this your first pregnancy? *

Yes

Secondary Contact First and Last Name; write N/A if not applicable

Secondary Contact Pronouns; write N/A if not applicable

Secondary Contact Email; write N/A if not applicable

Secondary Contact Phone Number; write N/A if not applicable

Any children in the home? If yes, please state the names and ages of each child. *

Any pets in the home? If yes, please state the names and breed of each pet. *

Do you have safe, reliable housing?
*

Yes

I am temporarily living with friends/family

I am temporarily living in a shelter

I am displaced/unhoused

I am a former Cavile resident temporarily living outside of Stop 6

Required

Preferred Method of Contact *

Phone

Text

Required

What is your total household income? *

$0-$30,000

$31,000-$60,000

$61,000-$90,000

$91,000-$120,000

$120,000+

Please state any financial barriers that you are experiencing (write n/a if not applicable) *

Please describe why you would like to receive doula support and how this would impact you and your family *

How did you hear about our program? *

Were you referred by Brave/R? If so, please state the name of the person who referred you; write N/A if not applicable. *

Please state any additional comments or questions *

A copy of your responses will be emailed to the address you provided.

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