Who is Client?

• Indicate the client's full name:

• Indicate the full mailing address of the Client:

• Select the Client's due date:

  !

  Due date is the estimated date when a pregnancy is expected to reach full term and childbirth is anticipated to occur.

• Indicate the planned location for the delivery:

• Does the Client have any existing medical conditions or complications related to their own health or the health of the baby?

  • No
  • Yes

• Describe in detail all known medical complications:

About this Agreement

• Select the date on which both parties sign this Agreement:

  !

  This is the date when this Doula Contract becomes effective.

• Select the state which laws shall apply to this Agreement:

  Choose option Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

  !

  The laws of a state selected as an answer to this question will apply towards execution, interpretation and termination of this Agreement.

  While the parties can select any state they want, the most common options include:

  – state where the doula’s business is registered or professional activity is performed;
  – state where the actual delivery will take place; or
  – state where the client currently resides.

• Provide the full name of the Client’s primary healthcare provider:

  !

  A primary healthcare provider is the licensed medical professional responsible for overseeing the Client’s prenatal care, pregnancy, and delivery.

Description of Services

• Specify the number of prenatal meetings and their frequency with the Doula:

• Select the format of the meetings:

  Choose option in person online (via Zoom) via phone via WhatsApp hybrid (both offline and online meetings)

• Specify the Client's delivery preferences (e.g., home birth, bath birth, unmedicated birth):

• Does the Client want to order postpartum services (e.g., recovery guidelines, help with breastfeeding, helping with household tasks)?

  • No
  • Yes

• Describe in detail the list of postpartum services the Client wants to order:

• Indicate the period of time within which the postpartum support shall be provided:

Payment Terms

• Which type of fees applies towards provision of services?

  • A fixed fee
  • An hourly rate

• Indicate the amount of a fixed fee, in U.S. dollars:

• Indicate an hourly rate, in U.S. dollars:

• How frequently the Doula should be paid for provided services?

  • Every month
  • Every week
  • Every other month

• How the fixed fee shall be paid by the Client?

  • in full on the date of signing
  • in full after the delivery
  • in several installments

• Describe the payment schedule:

• Indicate acceptable payment methods:

Miscellaneous

• Each party can end this Agreement by sending the other party a prior written:

  Choose option one (1) day notice three (3) days' notice seven (7) days' notice fourteen (14) days' notice

• Does the Client consent to the Doula using photographs or videos from prenatal sessions, labor, or birth for promotional purposes, including social media and other advertising platforms?

  • No
  • Yes

• Provide the Doula’s availability schedule, including specific days and times:

• Specify the gestational week from which the Doula will be on-call 24/7:

  Choose option 32 weeks 33 weeks 34 weeks 35 weeks 36 weeks 37 weeks 38 weeks

• Do you want to add a signature?

  • Yes
  • No

• Doula's signature:

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