Initial Inquiry for Doula Care
The Doula Access Initiative is eager to put you in touch with available doulas! Please fill out the form below and we will get back to you in a few days about next steps:
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Your Name *
What is your Estimated Delivery Date *
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What is your age?
Is this your first birth?
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Have you chosen a care provider? *
If you have chosen, who is your care provider?
Have you chosen where you plan to deliver? *
If you have chosen, where do you plan to deliver?
Address
Do you live in Tompkins County? *
Where are you comfortable receiving doula care? (please check all that apply) *
Required
Phone Number
How would you like to be contacted? *
Do you identify as Black or Indigenous? OR Does your income qualify you for the MOMS (Medicaid Obstetrical and Maternal Services)? *
What kind of doula care do you want? *
Is there anything else you'd like the doulas to know about you or your family and what support you are looking for?
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