Contract for Services

Tranquil Revolution Doula Services

Michelle Reed
Client Name: ________________________

Due Date: ___________________________

Contract for Doula Services

The following agreement is hereby entered into between Michelle Reed, referred to henceforth as “the doula” and __________________________, referred to henceforth as “the client,” with the following conditions understood and accepted by both parties.

Responsibilities of the Doula

• Prenatal Visit to discuss you and your partner's wishes and ideal birth experience including: previous history, any particular social, religious, cultural, medical factors which may play a part, form a birth plan, answer questions, address concerns, establish a rapport.
• On-Call formally (24/7), 2 weeks before your EDD (estimated due date)
• Once on-call provide client with phone numbers so she may be reached 24
  hours a day.
• Once called upon in labor, the doula shall stay with the client until one hour
  after the birth, unless otherwise indicated by the client, or there are exceptional
  circumstances. The doula will also provide at least one post-partum visit. It is
  the responsibility of the doula to inform the client of any dates or times she will
  be unavailable for service and shall arrange for backup services for those dates
  and times. The primary doula shall pay the backup doula for services rendered
  with no additional responsibility of the client.
• The doula shall provide physical, emotional, and informational support. The
  doula shall not perform clinical care provision. She shall not speak on behalf
  of the client, or make any decisions for the client. The doula shall NOT
  interfere with the interaction and role of the father.

Responsibilities of the Client

The client is responsible for informing her caregiver that a doula will be present

at her birth. The client and doula shall discuss preliminary plans, prior to labor,

for the arrival of the doula. When the client is in labor, she shall inform the

doula so the doula can make any personal arrangements. The doula shall be

given at least an hour and a half to arrive after the first phone call. The client

is responsible for paying the doula fees, as outlined below.

Doula Fees
• $500.00 is the total Doula fee.
• 50% due upon hire as a retainer for services
• 50% due at 38 weeks

Any failure of the doula to perform her services or provide adequate backup

support will be grounds for a complete refund of fees.

However, should she be unable to perform services as the result of failure to be

notified by the client (including failure to contact back-up doula), a rapid

labor, an emergency c-section, or refusal of hospital personnel to allow her

participation, there is no refund or discount of the fee agreed upon. No

guarantees of outcome are implied.

Should I change my mind about working with this doula, or there are changes

in my birth plans, which exclude the doula for any reason whatsoever, the doula shall retain any deposits made, with no further charges. Less than 30 day notice of cancellation, the FULL fee is payable to the doula.

WE, the undersigned, agree to the terms and conditions stated above and we

fully understand the responsibilities of the doula as well as our own.

Mother’s Signature:_____________________Date:__________________

Doula’s Signature : _____________________Date:__________________

Michelle Reed

6306 Prophet Ave.
Portage, IN 46368

michelleahlfeld@hotmail.com

219.742.7170

On-Call: _____________________________