I'm ready to connect with a doula!

First Name *

Last Name *

Pronouns *

Phone *

Email *

Partner/Primary Support Name

Partner/Primary Support Pronouns

Partner/Primary Support Email

City *

State *

Postal code *

Check all services you are looking for: *

Birth Doula Support

Postpartum Doula Support

Private Classes

Professional Photography

If you are considering more than one service, would you like to learn more about our Deluxe Doula Package?

Yes

What is your estimated due date? / When was your baby born? *

Is this your (first, second, third, fourth) baby? *

Where are you having your baby? (name of the hospital, birth center, or home) *

Name of your doctor or midwife? *

What is your maximum budget for birth doula care? These are our price points based on the doula's experience level.

$1,800

$2,200

$2,600

$3,000

What is your maximum budget for postpartum doula care?

$250 - $1,000

$1,000 - $3,000

$3,500 - $5,000

$5,000 - $10,000+

Do you plan on using insurance benefits to pay for doula services?: *

Yes

If yes, please specify the Insurance Company or Benefits Program you plan to use to cover doula services. *Please note: 1. We do not accept Oregon Health Plan (OHP) Medicaid. 2. If using insurance benefits, you are responsible for paying Birth First Doulas’ fees upfront. You can then submit our invoice to your insurance company for reimbursement.

If you are interested in professional photography, which package are you most interested in?

What qualities would you find most comforting and confidence-building in your doula? (For example: personality, energy, communication style, etc.) *

Do you have a specific type of experience or skillset that you'd like your doula to have? *

Is there anything about the doula's background or life experience that would give you a boost in connection? *

What else should we know about you and your life, history, or family structure? Is there anything else you would want a doula to know about you before they meet you? (For example: medical conditions, sensitive topics, etc.) *

What questions do you have for us?

How did you hear about Birth First Doulas? *

Terms & Conditions

By filling out this form and submitting it, I am exempting Birth First Doulas from all liability for any loss of information, though unlikely, that might occur through submission of this form and any email or text communications with Birth First Doulas or any of its independent contractor doulas. I agree to the privacy policy and terms and conditions provided by Birth First Doulas. By providing my phone number, I consent to receive SMS notifications, alerts/reminders, and occasional marketing communication from Birth First Doulas.