JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Application for Pre-Approval With The Doula Fund
This form is for Doulas who want to work with The Doula Fund to provide doula care to moms-to-be who cannot provide for it themselves.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What's your name?
*
Your answer
Are you certified?
*
Yes
No
Who is your certifying body?
*
Your answer
Are you a member of the Association of Ontario Doulas?
*
Yes
No
Are you insured? (We will be asking for proof of insurance)
*
Yes
No
The Doula Fund currently provides a maximum benefit of up to $650 for doula care. Will you be expecting clients to pay more than this?
*
Yes
No
Maybe
If you answered "maybe" or "yes" to the above, please use this space to explain.
Your answer
The Doula Fund has a minimum expectation of care to be provided to its clients. Please check all which you will be providing below.
*
Free initial consultation. (30-45 minutes)
Minimum 1 prenatal visit.(60-90 minutes)
24/7 support over phone, text or e-mail from the 37th week of pregnancy until birth.
Labour support during the entire birth itself. (Starting when the client requests you)
1 Postpartum visit (60-90 minutes)
Required
If you cannot meet the above minimums, please explain below
Your answer
Where did you hear of us?
My client
Another doula
Social media
Other
Clear selection
Would you be interested in being a part of a "Legacy Fund" program to provide for more doula care?
Yes
No
Maybe
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
