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Community Doula Client Agreement Form

I have read the Community Doula Client Agreement and know I can expect the following from my Birthing Gently doula:

  • I will receive 1-2 prenatal meetings

  • My doula will join me in active labor

  • I will have a doula with me for my birth and approx 2 hours postpartum

  • I will receive one postpartum visit with my doula.

  • I can call or text my doula with questions or concerns (between 8am-10pm unless urgent)

I have read the Community Doula Client Agreement and agree to provide the following to Birthing Gently doula:

  • I will stay in contact with my doula and communicate updates and changes to my pregnancy after provider visits

  • I will keep Birth Doula informed of my medical condition, including any test results so that the Birth Doula may answer any questions I may have, and best assist me in labor.

  • I agree to message the doula at the onset of labor, and at least two hours before I would like doula to arrive at the predetermined birth site. 

Release From Liability


In entering a commitment for Birth Doula service, I acknowledge that during the performance period of this commitment, services may be provided to me in my home, traveling to a medical facility and hospital. I understand that the aforementioned Birth Doula has a limited role pursuant to the descriptions of tasks outlined in the above-referenced commitment, wherever services are provided to me. The aforementioned Birth Doula has not represented to me that their commitment to services guarantees in any way a risk-free, emergency-free labor and birth experience. I understand that my Birth Doula does not make medical or nursing decisions on my behalf, including the decision when to seek medical care at a hospital or when labor support services are provided in my home. When services are provided in a medical facility, I acknowledge that my Birth Doula is not responsible for the performance of clinical tasks to include medical or nursing decisions regarding the inclusion or exclusion of treatments available to me, and my baby. Now, in consideration of the above acknowledgments, I on behalf of myself, ourselves, my heirs, administrators, personal representatives, executors, and assigns to release and forever discharge my Birth Doula from all damages or causes of action, either law or in equity, which I have or acquire or which may accrue to me, my administrators, personal representatives, executors or assigns as a result of using the Birth Doula services of my aforementioned doula, I intend this to be a complete release and discharge her from all liability whatsoever.

Thank you! We are wishing you a beautiful birth!

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