Sibling Doula Support Name * First Name Last Name Partner's Name First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Partner's Phone * (###) ### #### Email * Estimated Due Date * Sibling Name and Age * Intended place of birth and OB/Midwife's name * Any food or other allergies in the family? * List food and drink preferences and/or restrictions for sibling * Do you have any pets in the home? If so please note and include any special instructions * Do you or your partner smoke in the home? * Describe any specific characteristics, personality traits or requests with regard to caring for sibling * How did you hear about my services? Anything you would like to add? Privacy Policy and Disclaimer: All of your personal information will be kept private and will never be shared with anyone and will be used solely to help me best support you. It is your responsibility to share any and all relevant medical information with your healthcare provider. On-Call Deposit and Rate * I will arrive to support the sibling(s) asap, and within one hour of the phone call request. The fee for being on call for sibling doula support is $200 and $30/hr for the time attended. Additional siblings are $5/hr. The deposit of $200 is required at the time of booking to reserve support. Payment can be made with Venmo, Zelle, Paypal or check. By signing below, I acknowledge the above agreement and fees. ELECTRONIC SIGNATURE Thank you for your information! I am looking forward to supporting you and your family!
