Doula For The People Doula Inquiry Form (Standard)

Doula For The People Doula Inquiry Form

Liberation Is a Lifestyle
Doula For The People stewards a collective of 49 BIPOC-identifying doulas with diverse specialties and approaches to care. Many of our doulas accept insurance, including Medi-Cal, and can also be contracted through private, out-of-pocket pay.

If you’re looking for a doula who accepts your insurance or would like support finding a doula for private-pay care, please complete the matching form below.

Referrals are shared with our collective each Wednesday. If a doula is available and aligns with your needs and coverage, we’ll connect you by sharing contact information so you can begin coordinating care directly.
General Information
Full name of the person requesting services

First NameLast Name
What are your pronouns (He/Him, She/Her, They Them)?
Email Address
example@example.com
Client phone number
Please enter a valid phone number.Format: (000) 000-0000.
Location
Clients birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
When are you hoping to start support?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expected Due Date (if applicable)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Delivery location (if applicable)
What type of doula support are you interested in?
We honor your choice when selecting a provider. You can be matched with several providers and interview them, or we can match you with a provider we think would be a great fit. Please indicate how you'd like to be matched.
Do you have insurance (Private insurance or Medi-cal?)
If "Yes" who is your insurance provider?
Will you be using insurance or paying out of pocket? (We are only able to offer no-cost services through qualifying pathways)
How do you racially identify?
Do you, or anyone in your immediate family, have a history of mental Illness (e.g. Depression, Anxiety, Bipolar Disorder/Manic Depression, Obsessive Compulsive Disorder)?
At any point during your pregnancy or postpartum have you worried about how you were going to immediately pay for food or housing?
Do you have any food allergies?
Any medical issues, or other barriers to care that we should be aware of?
Partner/Support Persons Info

Not Required
Name of partner/support person

First NameLast Name
Partner/support person pronouns
Partner/support person phone number
Please enter a valid phone number.Format: (000) 000-0000.
Doula Matching Questions
Why is having a doula important to you?
What type of support are you most interested in receiving from your doula (All of our doulas are experienced in offering every type of support listed. This question is to get a sense of what is highest on your list of priorities)
What qualities are most important to you in a doula?
If your best friends could describe you with 3 words which 3 words would it be and why?
Do you have a preferred doula you would like to be matched with? If so, please share their name. (Link to doula headshots and bios https://doulaforthepeople.org/dftp-collective)
Have you been connected with these services through any of the organizations listed below?

Other
Should be Empty:

Doula For The People Doula Inquiry Form

General Information

Partner/Support Persons Info

Doula Matching Questions