Nessle - Provider Listing Interest
Thank you for your interest in listing as a provider on Nessle. We carefully review all submissions and will be in touch with you within 2 weeks of submission if you meet our criteria for listing on our site.
Please note that by filling out this form, you acknowledge that Nessle is a listing agent only and not an employer for experts listed on the site, and that you agree to indemnify Nessle and save it harmless against any and all liabilities, including judgments, costs and reasonable counsel fees, for anything done or omitted in your service to your clients.
Full Name (as you would like it listed)
Preferred personal pronouns
Business/company name (if any)
Your business/company website (if any)
Your business Instagram handle (if any)
In what city/town are you located?
Email (where you'd like to receive contacts from potential clients)
Please describe your role(s) in perinatal health, as you would like them listed on the site. (For example: Birth Doula, Certified Lactation Counselor, Prenatal Yoga Instructor). Please also mention if you are certified in the role(s), and if so, the certifying organization.
In which of the following categories would you like to provide 1-on-1 virtual coaching? (30-45 minute video session, plus 1 week of text or voice messaging) - SELECT UP TO 4
Prenatal self-care and preparation
Labor and birth
Postpartum care (self and infant)
Lactation and infant feeding
Perinatal fitness and movement
Child development and learning
Mental wellness and relationships
What total rate (USD$) do you charge for 1-on-1 coaching (On Nessle, this package includes one 30-45 minute call, followed by 1 week of text or voice messaging follow-up).
List 4 adjectives that clients use to describe you/your personality.
Are you currently offering/hosting any of the following services?
One-on-one video consults (using Zoom, FaceTime, or similar platform)
Texting or voice messaging on demand
On-demand online course
Live-streaming course or workshop
Online support group
Local, in-person support in my community
Training for other perinatal experts (such as business training, racial bias training, perinatal certifications, etc.)
Please send a square headshot to
along with your full name before submitting this survey.
I've sent it!
Thank you for your interest!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service