Birth Client Needs Assessment
Note: $20 mileage fee applies to clients to Kyle, Manor, Jonestown, Georgetown, Hutto, Leander, Lago Vista, Lakeway, Elgin, Bastrop, Lockhart, Spicewood, Bee Cave, Marble Falls, San Marcos and other towns not listed that are 15+ miles from Central Austin. Additional fee may apply for 40+ miles from Central Austin.
Terms of Service
Due to current confidentiality regulations all doulas should have a signed release form from their client before taking any notes about them, their labor, birth or postpartum. The best way to be fully compliant would be to get this release signature at the first prenatal visit, or upon first meeting and joining the client. Clients should receive a copy of the form they signed, and the doula should have her copy with her at all times to be able to show that she is indeed complying with the confidentiality regulations if questioned. Confidentiality of medical and personal information obtained during the course of the doula’s work is of the utmost importance. Failure to comply with these confidentiality regulations could result in penalties.
I, _____________(client), give my permission, for my ATX Doulas to take notes about me, including personal information I choose to disclose to her and information regarding my labor, birth and postpartum, as well as any information regarding my child/ren. I realize that this information will be shared with the doula that is providing back up support. I also understand that this information may anonymously be used for the for statistical purposes, and that my ATX Doulas doula may use this information to provide me with a summary for my own personal use.
We thank you for choosing ATX Doulas for your doula services. The doula who attends your birth will be assigned depending on the 24/7 on-call schedule based on the time you go into labor. Your postpartum doula will be matched for you based on needs, availability, and geography. This contract is an agreement between “client” (please print your name on the client line at the end of this contract) and ATX Doulas (“doula”). The doula will provide labor support for client’s birth, or postpartum support after delivery.
1.2 Birth Doula Services
Doula will accompany client to labor to help ensure a safe and satisfying birth experience. Doula will draw on her knowledge and experience to provide physical, emotional, and informational support to client and client’s partner. As your doula, we are working for client, not for client’s caregiver or the hospital. As soon as client thinks she is in labor, anytime day or night, she will call the ATX Doulas 24/7 phone number at 512.931.4404. Any additional services offered by doula will be demarcated below and explained in addendum.
1.3 Postpartum Doula/Night Nanny Services
Postpartum Doula’s will offer full time support with infant care, breastfeeding, sibling care, meal preparation, laundry, light housekeeping, emotional support, home organization, errand runs and safety tips. Postpartum doulas promote time for infant and family bonding while creating a sense of balance and organization during your recovery period. Night Nannies provide full time infant care on the overnight shift so parents can sleep.
Doula does not perform any clinical tasks or make any medical decisions that client and her health care provider may make during client’s pregnancy, labor, and delivery. Doula will not speak for client to medical staff, but will discuss concerns with client and provide information to help client make decisions before and during labor. Client understands doula is not responsible for clinical outcomes.
1.5 Refund Policy
The most current refund policy can be found here: https://www.atxdoulas.com/refunds-cancellation By clicking the Submit button, I agree to the terms of service.
- Clients must be paid in full by 37 weeks.
- HSA cards accepted
- If you choose to pay 50% now please use code 50%birth.