Birth Doula Services - Sliding Scale Inquiry Form

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I offer sliding scales because I believe that everyone deserves support regardless of ability to pay. The sliding scale is about trust. As a birth doula, I am trusted with a very intimate part of someone's life and making my services more accessible is one way I can show the same trust to my clients. I trust that you have thought about the value of my support and that you are experts in your own finances. Together, I hope we can come to a decision that reflects both.

Email *

First and Last Name *

Phone Number *

What is your current employment status? *

Employed full-time

Employed part-time

Temporary Employment

Freelance

Student

Unemployed

Which option best describes your household's employment status? *

Dual income (2 full-time working adults)

Single income (1 full-time working adult)

No income (1 or 2 unemployed adults)

Other:

Annual household income *

$25,000 or less

$25,000 - $50,000

$50,000 - $100,000

$100,000 +

Which of the following best describes you? *

I have access to financial security, own property, or have personal savings.

I am currently paying off debt/building my savings/finally moving away from living paycheck to paycheck, but I have access to steady income and spend little time thinking about meeting basic needs such as food, shelter, medical care, child care, etc.

I struggle to maintain access to needs such as health care, housing, food, child care, and am living paycheck to paycheck or I am in significant debt.

If you would like to provide some more information about your current situation, please do so here.

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