Postpartum Doula Agreement
Review the full Terms and Conditions of the Postpartum Doula agreement before submitting payment:
https://drive.google.com/open?id=1emI_jLi_HeNKbtyLuaVXZIe03C-r3wYm

Submitting this form will act as a signed agreement. Thanks!

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Postpartum Doula Selected *
Your answer
Due Date or date your baby was born *
Your answer
Name of you and your partner *
Your answer
Address- include city and zipcode please *
Your answer
What services are you desiring? *
Location for birth and provider name- doctor or midwife group
Your answer
email and phone numbers *
Your answer
email you desire weekly updated ebill to be sent to
Your answer
For full postpartum doula services, your final payment for the initial ten hours is due at the beginning of week 38, what date is that? *
Your answer
Soothing Sessions are paid in full prior to the doula scheduling. Retainers for full services are $125 and non refundable, what will your balance be? *
Your answer
What times of days and what days of the week are you desiring for full doula services? *
Your answer
Did you or do you plan to do placenta encapsulation?
Can you tell us about your birth plans or experience?
Any medical issues we need to know about
Your answer
What particular services are you most interested in from your doula?
Total fees *
Your answer
Today's Date *
Your answer
Please print your name as an electronic signature *
Your answer
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