Reserve your Due Date Birthing Person’s Name * First Name Last Name Pronouns * she/her they/them he/him other If other, please list pronouns below Phone Number * (###) ### #### Email * Today’s Date * MM DD YYYY Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Estimated Due Date * MM DD YYYY Support Person(s) Name(s) and Phone Number(s) Anything Additional I Need to Know Deposit Amount To Pay * Must be at least the $300 starting package unless otherwise discussed with doula $ Breathe Birth Care Doula Contract This contract is between Morgan Shipp (she, her) and client named below for postpartum doula care. Your doula agrees to provide the following care: • Non-medical physical and emotional support • Information and resources to qualified providers in the area • Postpartum comfort measures • Some infant care including feedings, changing and help with daily activities • Help with light chores and needs around the house such as laundry, dishes, organizing and general tidying • Meal prep • Grocery shopping • Belly binding • Parenting information • Overnight care if needed • Helps facilitate bonding between parent/guardian and baby The postpartum doula does not provide the following care: • Diagnose any medical issues or concerns of mother or baby but can refer you to a qualified provider if any concerns are noticed • Does not perform major household chores such as lawn care, or on going projects • Can not provide transportation for parent/guardian and baby • Doula does not assume complete care of the baby By signing this both doula and client agree to discuss needs and what services can be provided to best meet those needs. Some services listed above may not be needed for every client and others may need to be added. Payment Postpartum services are $20 an hour from 9 am- 9pm and $30 an hour from 9pm- 9am. Postpartum doula must be hired for a minimum of 12 hours with a deposit of $300 upfront. All other hours will be added on as needed and will be billed weekly. Payment plans and sliding scales available for those who need it. Doula and client will discuss a schedule that works best for both parties to meet the needs of the parent/guardian and baby. Schedules may need to change based on the needs of both parties and both agree to communicate any changes to the services offered or the scheduling. Doula will remain on retainer for 1 year after the birth to provide services. By signing this document both parties agree to payment and services to be provided as listed. Full Name for Digital Signature * First Name Last Name Today’s Date * MM DD YYYY Thank you! Someone on our team will reach out to you shortly to confirm your booking and invoice. Have a beautiful day! -Breathe Birth Care Thank you! Someone from our team will reach out to you shortly.