Client Intake Form
Thank you for including us on your journey. When we receive your form, our doulas will check to see if we can meet your needs within our schedule of availability. Someone will contact you within the week to let you know, and if so, book an initial consultation with one of our doulas. If you have not received a call by then, please feel free to send another form and/or give us a call at 604-719-6390.

What to expect at your first visit: You will have a 30-45 minute visit where you will meet one of the doulas on your assigned team (we tend to work in partners). During this time, your doula will discuss with you what to expect from doula care in general, as well as how this may apply to your specific needs.

In the meantime: You may also want to check out our online community on Facebook, https://www.facebook.com/ekwi7tldoulacollective/

Privacy policy: By sending in your form you have given us your email. We have never and will never sell or distribute your email in any way, but use it only for communication between you and our collective.

Email address *
Name *
Your answer
How do you identify? *
Required
What types of services are you interested in? *
Required
What is your gender? *
Which gender pronouns do you use? *
Which city or community do you live in? *
Your answer
Cell phone *
Your answer
If applicable, when is your estimated due date?
Your answer
If you already know, which doula would you prefer to work with?
Your answer
Primary care provider
Primary care provider: name and practice
Your answer
If applicable, where do you plan to give birth?
If applicable, which hospital are you registered with?
Your answer
Are you travelling into Vancouver from out of town to give birth?
Are you interested in accessing the BCAAFC Doulas for Aboriginal Families Grant? *
How did you hear about us? *
Required
Is there any other information you would like to share with us?
Your answer
A copy of your responses will be emailed to the address you provided.
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