Roots & Wings Midwifery
Roots & Wings Midwifery - Doula Application
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Do you have any training or certifications?
How many years have you been a doula?
Less than 1
1 to 3 years
3 to 5 years
More than 5 years
How many births have you attended as a doula?
How many births do you generally attend each month?
What is your availability and are there times when you are not available (other than vacations)?
Please describe your doula style and what you see as your role at a delivery.
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)?
Have you ever attended a home birth?
If yes, please describe that experience.
Have you ever missed a birth?
If yes, please describe the circumstances.
What is your fee?
What is included in your care?
Is there anything else you want to tell us?
©2019 Roots and Wings Midwifery, LLC │ Knoxville, Maryville, Oak Ridge, Kingston, TN │ firstname.lastname@example.org
Office Address: 4873 Chambliss Ave Knoxville TN 37919