Booking Form - Doula Support Packages
Please complete the form below to book my doula services.

Christa Buckland
BHlthSc (Health Promotion), MPhil
www.BoldBeautifulBirth.com 
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If you have any questions please do not hesitate to contact me. :)

0422 229 312
boldbeautifulbirth@gmail.com 
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Email *
Which package are you booking? *
Required
Name *
Phone number *
Address *
Estimated Due Date (EDD) *
MM
/
DD
/
YYYY
Birth Companion Name *
Relationship to you (e.g. spouse, partner etc.) *
Intended place of birth (e.g. name of hospital, birth centre or home) *
Care Provider *
Required
Care Provider Name (if applicable)
Is this your 1st, 2rd, 3rd, etc. baby? *
Is this birth a VBAC (Vaginal Birth After Caesarean)? *
Is there any important information you wish me to be aware of?
How did you find out about me? *
Required
Payment Terms
Payment & Refunds:
All doula packages require 50% of the total package fee upfront and is non-refundable. Balance remaining must be paid by 34 weeks (according to the EDD you provide in this form). After 34 weeks, no portion of the fee is refundable. This compensates me for time spent with you as well as the loss of opportunity to work with other clients (see Letter of Agreement for Doula Services for full details).

Payment plans are available! A payment plan can be suited to your needs but usually entails set monthly payments via your credit/debit card. As per above, 50% of the total package fee is non-refundable. The total package fee should be paid by 34 weeks. After 34 weeks no portion of the fee is refundable.

Refunds are not given for change of mind.

Please check the box below to acknowledge that you have read and understand the above terms. *
Required
Payment Information
Please submit this form (Step 1) and then attend to payment (Step 2) to confirm your booking. The payment links and information will be on the following page. There are a number of payment plans available. Payment options include credit/debit card (PayPal/Stripe) and direct deposit (EFT). 

Click the submit button below to view the payment links.

SUBMIT YOUR BOOKING
Please click the submit button to book this service.You will receive a copy of this form via an email from GoogleForms - please check your junk folder. IF YOU DO NOT RECEIVE AN EMAIL, THE FORM HAS NOT COME THROUGH. Please contact me if you have any issues submitting this form.

A copy of your responses will be emailed to the address you provided.
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