);

------------------------ Register Now - The Birth Doula Program ------------------------

To register in our program please complete the following form. You will then be contacted to schedule an in-person consultation with one of our doulas to see if she’s a good fit for you. These sessions will be conducted in the comfort of your home. You won’t be charged for any service until and unless we find a doula you are comfortable with. We accept Visa/MC/Amex or etransfers for payments.

If you’re just looking for more info, use the contact form here instead.

Name:*
E-mail:*
Partner's Name (if applicable):
Address:*
Phone:*
-
Due Date:*
Where are you having your baby?:*
Which Program did you want to register for?:*
Doctor's name or midwife practice :*
Is this your first baby? If no, please list the number of previous births:*
Please tell us your age:*
Do you speak English? Please list other languages you speak:*
Do you want to Breastfeed your Baby?:*
Do you have plans for the use of medications in labour? Please tell us your thoughts. It's ok if you aren't sure.:*
Do you have any health issues or cultural issues that we should know about? If so, please tell us so we can do our best to accommodate them:
I agree to the terms of service, including the cancellation policy found here: birthdoulaprogram.ca/terms-of-service*
Anything else you'd like to share with us:
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