It Takes a Village!
Let's pull together to give you the best possible experience you can have during your perinatal journey! Harambee Village Doulas provide social, emotional, physical and educational support throughout your pregnancy, labor, postpartum and beyond.

Thank you for your interest in working with Harambee Village. You will hear back from our intake specialist within 7 days . Please note that submitting a referral does not guarantee services.

If you have an urgent matter please call our on-call doula line at 608-535-9525. Do not send in an online referral for urgent matters! If you have any questions please send us an email at info@harambeevillage.org
Are you a pregnant parent, a provider, or a Harambee Partner Organization *
If a provider, or HVD partner, please specify your affiliation below:
If a provider, or HVD partner, please provide contact information below *
If a provider, or HVD partner, does your client know you are making this referral?
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Birthing Person First Name *
Birthing Person Last Name *
Birthing Person Date of Birth *
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Estimated Due Date or Date baby was born *
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Email *
Phone *
City *
Name of Insurance *
Insurance Number
The best way to contact the birthing person: *
Desired Services: *
Required
Client will be giving birth at:
Do any of the following apply to you, or your client? *
Required
What are your preferred pronouns?
Is your pregnancy considered a high risk pregnancy? *
If you answered yes, please explain
Have you come in contact with anyone with COVID-19 in the last 30 days? *
Have you experienced chills, fever, or any other symptoms of COVID-19 in the last 30 days? *
Have you traveled out of the state in the last 30 days? *
Please write your initials below to declare that the information you have provided is accurate and complete. *
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