Register Online for Doula Services

Welcome to our online registration for Doula Services. If you have any questions, please do not hesitate to contact us by email or by telephone at (204) 792-6769.

Step One

Please review the following details about Birth Doula Services:

The fee for Doula Services is $550 (plus GST)
Our typical payment plan includes a deposit of $150 (plus GST), and two additional post-dated payments of $200 (plus GST).
If necessary, we will happily design an alternate payment plan that will meet your needs.
We also offer our services on a sliding scale to a limited number of low-income families each year, subject to availability. If you would like to apply for our sliding scale, please complete the sliding scale section of our registration form.
Once you have registered, your doula will contact you within about a week. We usually match you with your doula based on availability at your due date and geographic area. If you have any special requests, you may indicate them on the registration form. If for any reason you do not feel well-matched with your doula, you can certainly meet with another doula.
When your doula contacts you, she will book a free, no-obligation 45-minute consultation. At this consultation, your doula will discuss all the details of our services and answer any questions you have.

Step Two

Please complete the following form. This information helps us get to know you better so we can best meet your needs. Alternatively, you can phone us at (204) 792-6769 and we can complete your registration over the phone.

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Mother's Name:

Mother's Age: Due Date:

Partner's Name, if applicable:

Is your partner attending the birth?

Address:

Area/Neighbourhood:

City: Postal Code:

Phone Number:

Work Number: Can you be reached at work?

Email Address:

Would you like to be added to Birth Roots Connections, a listserv for our clients to share information and experiences? (You can unsubscribe from this listserv at any time.) Yes No

Will anyone else be attending the birth?
If so, please indicate their name, relationship to you, and their phone number:

If you have other children, how old are they?

If applicable, please briefly describe your previous births:

Place of Birth:

Is your caregiver a:

Midwife or Doctor's name:

Are you planning to breastfeed?

If you have other children, did you breastfeed them and for how long?

Are you planning to take/have you already taken prenatal classes?
If so, where are you taking them/did you take them?

If you have any specific requests for a doula, please describe them here:

If you have used the services of a doula before, please indicate when and where:

How did you hear about us?

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SLIDING SCALE:

Please complete the following questions if you wish to apply for our sliding scale.

I would like to apply for a doula on a sliding scale.

Unfortunately, we are only able to offer our services on a sliding scale to a limited number of low-income families, and the following information will help us assess your eligibility:

I currently receive social assistance
I currently receive the healthy baby supplement. I receive per month

Please press the 'Submit' button to process your registration.