PALS Doula Request Form

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Who is requesting a doula? *

Expectant Family

Healthcare Provider

Other:

Your name *

Email to contact *

Phone # to contact *

Birthing person's name (if not same as above)

City/neighborhood where birthing person resides *

Where is the birthing person planning to deliver? *

EDD? *

YYYY

Type of doula? *

Certified

Certifying

Either

Do you identify as BIPOC (Black, Indigenous, Person of Color)? *

Yes

Do you wish to be connected to BIPOC (Black, Indigenous, Person of Color) Doulas? *

You can also search for BIPOC doulas at birthforthepeople.com (A local directory of BIPOC perinatal professionals) as well as www.doulamatch.net

Yes, only BIPOC doulas

No, all doulas available

Budget *

$1500+

$1000 - $1500

$750 - $1000

$500 - $750

$500 and below

Pro Bono/no cost (We strongly encourage you to find some exchange that values the time of the doula if requesting probono services. This may be an offer to pay for additional costs that are left to the doula such as parking, childcare, meals, or even lost income from another source during thier support. On average, a doula spends not just the 12-24 hours, but an additional possible 840 hours that encompasses the 5 week period that a birthing person is likely to deliver in of 37-42 wks *plus* being available to the family served with prenatal and postpartum contact/meetings/email/phone support. PLEASE VALUE THE TIME OF THE DOULA)

Preferred method of contact *

Phone

Any additional details you wish to share? Specific knowledge or experience requested to best serve family? *

Submit

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