Virtual Doula Intake

We are honored that we will be working with you! We ask you to fill out this information so we can learn a bit more about you, your partner, and your new baby. 

Please mail any necessary documents to: 1289 Fordham Blvd, Suite 106, Chapel Hill, NC 27514

Contact Emily at Emily@CarolinaBirthAndWellness.com or 919/480.1423 if you have any further questions.


Payment

Each 60 minute virtual doula session is $60 per hour.

Payments can made online, via PayPal, over the phone, or you may mail a check to our mailing address.

Packages

If you buy three or more virtual sessions, each consult is $50 per hour.


Client Intake

Personal Information
Name *
Name
Phone *
Phone
Address *
Address
Partner Information
Partner's Name
Partner's Name
Partner's Phone
Partner's Phone
Pregnancy Information
Baby's Name (if sharing)
Baby's Name (if sharing)
Estimated Date of Delivery
Estimated Date of Delivery
Virtual Doula Specifics