Client Intake Form

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Client Intake Form

After you fill out this order request, we will contact you to go over details and availability before the order is completed. If you would like faster service and direct information on current stock and pricing please contact us at Contact us at (703) 739-2832 or (703) 739-2831, or by email at support@momease.com

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Which services are you wanting?

Please identify which service/services you are interested in. We look forward to following up to begin the discussion of how we can meet your needs within 48 hours.

Personalized/At Home & Hospital Support - $2000 (5 prenatal visits & 1 postpartum)

Personalized/Full Service at Hospital $1700 (5 prenatal visits & 1 postpartum)

Team Doula Service- $1300 Hospital Package (3 prenatal visits & 1 postpartum)

Student Doula Service $600 to $1000 or sliding scale (3 prenatal visits & 1 postpartum)

Planned C-Section Doula - $1300 (3 prenatal visits and 1 postpartum)

Postpartum * Welcome Home Package - 9 hours for $450

Postpartum * Baby Basic at Home - 15 hours for $675

Postpartum Customize or Carrot Services more that 20 hours * Fee TBD

Night Service Service * More than 16 hours * TBD

Not Sure

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