Discounted Fees Eligibility Form
If you are unable to pay the advertised fees for Doula services you may apply for a discounted fee based upon your income. Please complete this form in its entirety for review. I will contact you to discuss a fee that appropriately reflects your situation.
Your answers will be kept on file and in strict confidence.
**PLEASE NOTE THAT YOU MAY BE ASKED FOR A COPY OF 1040 OR A FEDERAL TAX FORM TO VERIFY INCOME**