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Virtual Doula Application
SPACE IS LIMITED. Please apply below.
* Indicates required question
First name:
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Your answer
Last name:
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Your answer
Email address:
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Your answer
Phone #:
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Your answer
Your partner's name:
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Your answer
Is your birth under the prenatal care of a midwife?
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Yes, Midwife
No, OB
I have no prenatal care
Other:
Which trimester are you in right now?
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1st trimester
2nd trimester
3rd trimester
Due anyday!
Is this your first pregnancy? If not, briefly describe previous births.
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Your answer
On a scale from 1-5, how important is it to you to achieve your natural birth?
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1 - somewhat important - I'll try to do it naturally
2 - pretty important - I want a natural birth but I'm scared
3 - very important - but I'll bail if necessary
4 - super important - I'll most likely pull it off
5 - extremely important - I'm committed 100%
Other:
What state/province do you live in?
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Your answer
Where do you plan to give birth?
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Your answer
On a scale from 1-5, how supportive is your partner of your birth plan?
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1 - my partner doesn't support my plan at all, he won't even discuss it
2 - my partner is open to discussing my plan, but we disagree
3 - my partner is neutral about my plan, he's leaving it up to me
4 - my partner likes my plan, but has a couple concerns
5 - my partner is 100% on board with my plan
Other:
What sort labour preparation have you done for your birth so far, if any:
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Your answer
What is the #1 thing you like about the concept of a virtual doula?
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Your answer
THANK YOU FOR YOUR APPLICATION!
If you are approved, I will text you to confirm, we will set up a time to chat + I'll email you a payment link! 🤍
Submit
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