Postpartum Doula Contract

Postpartum Doula Support

As a postpartum doula, it is our goal to help you adjust to the many changes and new challenges you may encounter with a new baby. It is our hope that when you have support, those challenges can feel less overwhelming, your confidence may be higher and your new family can bond and flourish.
Babys Name

First NameLast Name
Mothers Name*

PrefixFirst NameLast Name
Spouse/Partner Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Rate:

$50 per hour under 10 hours a week:

$40 per hours over 10 hours a week:

What is included for your fee:
- Baby soothing techniques
- Offers breastfeeding or bottle feeding support
- Explains normal newborn behavior
- Assist with the baby’s laundry
- Light house work
- Preparing simple nourishing meals
- Help the entire family adjust and settle in
- Creating a new daily routine that works for you
- Care of newborn while mom rests or bonds with other children
- Educate fathers on what they can do to help
- Baby Monitoring while mom is resting
- Overnight care
Limitation of Services:
- As non-clinical support providers: We will not:
- Administer any type of medications, prescriptions or over the counter medication to you or your baby.
- Do any major housecleaning duties
- Take over the care of the baby
- Discipline children
- Transport any member of the family.
- Provide Nanny Services
Grocery:
For errands and grocery shopping, you would be responsible for the necessary funds for items to be purchased before the errand.
What is your due date or the date you gave birth?*

MonthDayYear
Date
What are your primary needs. *
Notification of birth:

Please notify your Doula within the first 24 hours after the birth of your baby(s) to make appropriate arrangements. We require 48 hours notice prior to services beginning. Unless otherwise agreed upon and noted below.
Days of Services

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Hours

MorningAfternoonEvening
Who is your primary Doula?*
Cancellation of Service

Please notify me 24 hours in advance if you need to reschedule a day of service to avoid a $25.00 late-cancellation fee. This fee does not apply in the case of a true emergency or severe weather condition cancellations. Once you have signed this contract if you decide for any reason other than a hospitalization of the mom/baby that the signed upon services are no longer needed you are still responsible for only the deposit amount. The remainder of the contract will be refunded back to you. You will be notified 24 hours in advance if your Doula needs to reschedule service for that day due to an illness. If your Doula is not available a back-up doula will be provided for you. If you choose not to use a backup Doula, you can make arrangements to reschedule.
Agreement

I/We have read this letter describing postpartum services and agree it reflects the discussion I/We had with her. I/We have read all statements contained herein and I/we fully realize that I/we are signing a complete release and bar to any claims, which I/we have or believe I/we may have resulting from our contract for postpartum doula services.
Signature

Clear

My Products

Postpartum Retainer$150.00

If requesting 10 hours or less. $50.00

Total Hours

If requesting more than 10 hours.$40.00

Total Hours

Subtotal $0.00Tax $0.00Total $0.00

Credit Card

How will you be feeding your baby?*
Should be Empty: