Booking Form
Please complete the form below to book my doula services.

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If you wish to book any of my other services please refer to the following links:

***TO BOOK MY PLACENTA ENCAPSULATION SERVICE PLEASE CLICK HERE*** https://goo.gl/forms/8TZg5iI8OQHItWCw2

***TO BOOK HYPNOBIRTHING AUSTRALIA™ COURSES PLEASE CLICK HERE***
https://goo.gl/forms/XjZokCiBfLP9VBJi1

***TO BOOK POSTNATAL SERVICES PLEASE CLICK HERE***
https://goo.gl/forms/eCLIYOskBgTLEJBC2
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If you have any questions please do not hesitate to contact me. :)

Christa Buckland
BHlthSc (Health Promotion)
Doula, Hypnobirthing, Online Programs
0422 229 312
christabuckland@outlook.com
Email address *
Which service are you booking? *
Required
Name *
Your answer
Phone number *
Your answer
Address *
Your answer
Estimated Due Date (EDD) *
MM
/
DD
/
YYYY
Birth Companion Name *
Your answer
Relationship to you (e.g. spouse, partner etc.) *
Your answer
Intended place of birth (e.g. name of hospital, birth centre or home) *
Your answer
Care Provider *
Required
Care Provider Name (if applicable)
Your answer
Is this your 1st, 2rd, 3rd, etc. baby? *
Is this birth a VBAC (Vaginal Birth After Caesarean)? *
Is there any important information you wish me to be aware of?
Your answer
How did you find out about me? *
Required
Payment Information
Birth Doula Support Package ($1997) includes:
- Birth doula service
- Hypnobirthing Australia Group course
- Bold Beautiful Birth Antenatal Support Program (online)
- Mastering Affirmations Mini Course (online)
- Effective Birth Plans (online)
To book this service, please pay your deposit here: https://www.boldbeautifulbirth.com/offers/jodobmaR
This will give you instant access to the online content.
**This link will open in a new tab/window. Please remember to scroll to the bottom of THIS page and click submit so that I receive your enrolment details!** :)


For all other services, my preferred payment method is PayPal. Please pay via this link:
https://www.paypal.me/ChristaBuckland

OR

Direct Deposit Details:
Bank: Commonwealth Bank
BSB: 062-692
A/C: 37571348
Name: Christa Buckland
Payment Terms
Fees:
Doula service - $1997

Payment & Refunds:
For doula service: 50% of the total doula fee is required upfront and is non-refundable. Balance remaining must be paid by 34 weeks (according to the EDD you provide in this form). After 34 weeks, no portion of the fee is refundable. This compensates me for time spent with you as well as the loss of opportunity to work with other clients (see Letter of Agreement for Doula Services for full details).

Please let me know if you need a payment plan! A payment plan can be suited to your needs but usually entails set monthly payments via your credit/debit card. As per above, 50% of the total doula fee is non-refundable. The total doula fee should be paid by 34 weeks. After 34 weeks no portion of the fee is refundable.

Refunds are not given for change of mind.
Please check the box below to acknowledge that you have read and understand the above terms. *
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A copy of your responses will be emailed to the address you provided.
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