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Birthing Gently Doula Profile Setup

Please fill in the following form information to get your Birthing Gently profile page set up.

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Your personal information is only for our doula roster, and will not be published or shared. This includes your W9, insurance information, phone number, address and personal email address.  We use these only to conduct Birthing Gently business and stay connected with you. Documents you upload are stored securely and accessible only to Birthing Gently administration.

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NOTE:  We may lightly edit your bio and adjust your photo for consistency with our site style. We'll always represent you accurately.

Which roles will you be fulfilling with BG?
Please choose appropriate training/cert for you
Upload PDF
Upload supported file (Max 15MB)
Upload PDF
Upload supported file (Max 15MB)
Areas of focus or specialty: ensure you have extended training or certification in this area
Please check if you are enrolled with:
Upload Photo
Photo looking at camera and smiling. Nature background preferred.
Upload insurance card PDF File
Upload supported file (Max 15MB)
Upload W9 PDF File
Upload supported file (Max 15MB)

Thank you!  Your profile will be live as soon as your information is verified.

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