ROOTS & WINGS MIDWIFERY
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Roots & Wings Midwifery - Doula Application
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Indicates required field
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Email
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Do you have any training or certifications?
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How many years have you been a doula?
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Less than 1
1 to 3 years
3 to 5 years
More than 5 years
How many births have you attended as a doula?
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How many births do you generally attend each month?
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What is your availability and are there times when you are not available (other than vacations)?
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Please describe your doula style and what you see as your role at a delivery.
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Do you have any particular clientele you are not comfortable working with (such as hypnobirthing parents, someone who has not taken a childbirth class, etc)?
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Have you ever attended a home birth?
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Yes
No
If yes, please describe that experience.
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Have you ever missed a birth?
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Yes
No
If yes, please describe the circumstances.
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What is your fee?
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What is included in your care?
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Is there anything else you want to tell us?
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Submit
The Team
Home Birth Services
Midwifery Care
Placenta Encapsulation
Group Prenatal Care
FAQ
Testimonials
Cycle Charting
Preparation
Nutrition for Fertility
Nutrition for Pregnancy
Pregnancy Essentials
Exercise
Nutrition for Postpartum
News
Contact
Birth Stories