test - The New York Baby

Are you a doula and curious about getting referrals from The NY Baby? Fill out our form here

Nice to meet you {{_name}}!

Are you interested in getting referrals through NY Baby?

Yes

No

Are you looking for doula-trainings?

Yes

No

Thank you {{_name}}

Are you currently offering in-person doula-services?

Yes

No

Are you currently offering virtual doula-services?

Yes

No

Ok {{_name}}, we need more information about you

Zip code where you live:

Website:

Doula training certification agency:

Date of certification:

What kind of certification?

Birth

Postpartum

How many births have you attended?

How many postpartum families have you worked with?

All right {{_name}}, do you need more information about the you?

What kind of business entity are you (i.e. LLC or .inc)?

Which liability insurance do you have?

How many births/postpartum clients would you like to take on per month?

What is your current rate for birth and postpartum support and what does it include?

Which areas do you serve?

Which areas do you not serve?

What languages do you speak?

Great {{_name}}! There are some questions left.

Do you have children?

Yes

No

Do you have a car?

Yes

No

Do you have any pet allergies?

Yes

No

Do you have the Covid19 vaccine?

Yes

No

What other doula-related certifications do you have?

What did you do before becoming a doula?

What inspired you to become a doula?

Do you work 100% as a doula or do you have another profession?

If another profession, how will it work for you with being on call?

What is your availability in the upcoming months?

*Full Name

*Phone Number

*Email