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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 or etransfers for payments.

Please note this form will REGISTER you in our program. It is the contract between you and us. If you’re looking for more info, use the contact form here instead.

Name:*
E-mail:*
Partner's Name (if applicable):
Address:*
Phone:*
-
Due Date:*
Which Program did you want to register for?:*
Which hospital are you delivering at:*
Doctor's name (or midwife) :*
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:
What is a Doula? * What is a doula?: The term “doula” comes from the Greek word for a “woman who serves”. A birth doula is a professional labor assistant who accompanies women in labor to provide emotional support, physical comfort, and facilitate communication with caregivers to help clients feel fully supported and satisfied with their birth experience. Birth doulas can provide reassurance and perspective and help with relaxation, comforting touch, positioning and other techniques for comfort. What doulas do not do: As a doula we do not: • Perform clinical tasks such as blood pressure, fetal heart checks, vaginal exams, etc. • Make decisions for you. (we will help you get the information necessary to make an informed decision) • Speak to staff instead of you regarding matters where decisions are being made. (We will discuss your concerns with you and suggest options if appropriate, but you or your partner will speak on your behalf to the clinical staff:*
Cancellation and Failure to provide services: We will make every effort to provide the services described here. Sometimes this is impossible (for example, a rapid labour). If our failure to attend your birth is due to our error, there will be no charge for our birth services and we will refund half your fee (the remaining half is for the prenatal and postpartum visits). If it is due to your failure to call us, no refund is issued. Birth can be a very unpredictable event, and although we will provide physical and emotional comfort to be best of our ability, we cannot guarantee you a problem-free birth. Because we have booked a spot in our doulas' schedule to be available to you for the month of your due date there is no provision for cancellation of service within 60 days of your due date. Over 60 days we will refund minus an administrative fee of 25% of unused services (prenatal/postpartum visits are 50% and birth is 50%):*
Liability and Confidentiality The client will indemnify Discover Birth and its team doulas against professional loss, damage, costs and expenses which may incur as a consequence of any act, omission, negligence or default of the doula in connection with or in performance of the services. Discover Birth is also involved in the training of other doulas/childbirth educators and advocacy in the community to increase the awareness of safe choices. As part of that work we would like to have permission to discuss the particulars of your prenatal, birth and postpartum experience. Clients’ names are never used when discussing this information unless the apprentice will be working with you. We would like permission to share information about your plans and goals specifically with the other members of our practice. This information is always considered very confidential. By signing this release you agree to the above use of information related to the services provided to you by Discover Birth and its sub-contractors:*
Anything else you'd like to share with us: