Discounted Doula Services Application
Fill out this form to find out if you qualify for free or significantly discounted doula services provided by members of the Utah Doula Association.
Email address *
Name *
First and last name
Your Date of Birth *
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Baby's Estimated Due Date *
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Phone number *
What city do you live in? *
Where do you plan to deliver? *
Who is your doctor/midwife? *
Do you have an FSA or HSA? *
Why are you applying for discounted services? *
Are you or your partner a veteran of the U.S. military? *
Are you or your partner a member of law enforcement or emergency services? *
What number of pregnancy is this? *
If you have had a previous pregnancy, what was the outcome of the pregnancy/birth? *
Have you taken a childbirth education class this pregnancy? If so, what class and where? *
Any other considerations we should take into account *
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