Tell us what you are looking for in a birth doula, and what kind of person you feel would best support you in your hopes and preferences for birth.
Medicaid Insurance *
This form is for those who have insurance through an employer, or purchased individually. I understand that if I have a Medicaid insurance plan, I am eligible for the Core Program and to receive a doula at no -out-of-pocket cost. To request a doula through the Core Program I should NOT fill out this form, and instead go to the REQUESTS/REFERRALS page.
Anything else you would like us to know?