Client Inquiry Form 
Thank you for your interest in retaining Doula 127 during this exciting time of your life. 

Complete the inquiry questionnaire to help me understand your current needs. I look forward to supporting you and want to ensure we are a good fit! 
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Email *
First Name and Last Name
Phone Number 
If you are pregnant what is your expected due date (EDD)? 
What city do you reside in? 
Planned Birth Location 
What is your marital status? 
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Did you use the service of a Doula in a previous pregnancy? 
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Do you have health Insurance? If, yes, what type of insurance? 
What do you hope to get out of Doula support services? 
I am dedicated to supporting my clients through this incredible time in their life to support an empowered experience. The current investment is below- which option works best for you? 
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Is there anything else you'd like to share with me?
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