Doula Services Registration
As a birth doula, I accompany women in labor both in person and virtually if needed to help attain a satisfying birth experience. I draw on all of my professional training, knowledge, and experience to provide emotional support and physical comfort, and facilitate communication with staff so that you can make informed decisions as they arise in labor. I can provide reassurance and perspective to you and your spouse or birth partner, make suggestions for labor progress, and help with relaxation, massage, positioning and other techniques for comfort. I am independent and self-employed. As your doula, I am working for you, not your caregiver or birth facility! For more detailed information on what a doula does, please read my contract (link at the bottom of this form). Smiles - Jenny the Doula
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Mother's Name *
Estimated Due Date *
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Cell phone number *
Spouse/Partner's Name
Partner's or Secondary mobile number *
Mother's Email Address *
Mother's Physical Address *
Name of Obstetrician or Midwife
Place of Birth (home, hospital, birth center)
I am registering for the following service(s): *
Required
How did you hear about me?
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