Doula Mentor Program

Doula Mentor Program

Please fill in the form below.
Full Name *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email *
example@example.com
Phone Number *

Area Code Phone Number
Program Details:

2 Hour Orientation:

Overview of program
Mentee expectations
Mentor expectations
Mentor Worksheet

2-4 Client Review:

Overview for each client that you will shadow

2-4 Prenatal Appointments per client:

Attendance at client prenatal appointments
Review of each appointment

2-4 Births:

Attendance during clients labor and birth

Follow up appt after the birth:

Review of day of labor and birth

1 Postpartum appts:

Attendance at 1 postpartum appointment

Fees:

$400 Total for non-contracted Doulas

$300 Total for contracted Doulas

$100 non-refundable deposit due when you sign your agreement. Remaining balance due 1 week prior to orientation.

*1 hour insurance billing workshop if you choose to participate in the Medicaid pilot program. Workshop to be held, immediately after orientation if you qualify. If not the workshop will be held on a seperate day.*

*Contracted Doula pay an annual fee of $250.*

Optional:

*Option to sign as a contracted Doula working Doula under Calming Nature Doula Center.*
When did you complete your training? *
Do you speak any foreign language? If so please list them below.
Where did you complete your training? *
What organization did you complete your training? *
How many births have you attended? *

0 1-3 4 +
Orientation Dates *
Payments can be made via cash, check, or money order to:

Calming Nature Doula Center
By Mail:
223 Grant St.
Buffalo, NY 14213
Memo Line: Mentor Program

You can also make your payments directly to us via:
Our website https://www.calmingnaturedoula.com/shop

or
Cash App: $CalmingNatureDS

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