Thanks so much for allowing me to serve you in your pregnancy, birth, and postpartum period. Please read through and select “I agree” on my intake and consent form. A copy of this form and service agreement will be emailed to you for your records. Payment can be made via cheque or e-transfer. A deposit of 50% of your selected service will be due upon signing and the remaining 50% will be due at or directly after our second prenatal visit.

Service Agreement

Thank you for booking childbirth serves with me. Your package includes prenatal visits, on-call birth support, and postpartum visits as outlined in the package you selected. Please read careful, particularly the areas around on-call time and visit scheduling.

PRENATAL / POSTPARTUM VISITS

Your prenatal and postpartum visits will be scheduled by you online, and will typically take place in your home. Because birth is unpredictable, I occasionally need to reschedule (sometimes at the last minute) in the event that I am with a birthing woman. When your time comes, I will similarly reschedule my other social and business meetings in order to be with you at your birth. Occasionally, a partner doula may be provided to fulfill prenatal or postpartum visits.

It is your responsibility to re-book online if you need to reschedule a booked meeting. If you miss out on a prenatal visit because I had to cancel one and you have your baby before we are able to reschedule the minimum number of prenatal visits included in your chosen package, you are entitled to a $97.5 refund (1.5 hours @ $65/ hour). Postpartum visits are typically done within the first week following birth. I do my best to take the lead on arranging these with you, but it is ultimately your responsibility to reach out and be part of initiating these to take place within the first week. If you attempt to reach out and I do not make myself available to you in that first week, you are entitled to request a $97.5 refund (1.5 hours @ $65/ hour) for any postpartum visits guaranteed by your package. If you do not reach out with the first week, or decline a visit from me or a partner doula refunds do not apply.

ON-CALL TIME

Even though you have been given a "due date", there is a 5-6 week window that could be considered healthy full-term pregnancy.  Due to the unpredictability of when your baby will come, I can never absolutely guarantee availability on the day you birth. There is always a very small possibility that I will be unavailable due to of circumstances such as personal illness, family emergency, or a conflicting birth. In this event, a carefully selected colleague would be provided to support you in my place.

Due again to the unpredictability of birth work in both timing and length, it may become necessary for me to take a rest break in the event of a long birth. Part of my role early in the process is to work with your other support people (partner, family, etc), spelling each other off as needed so everyone is well rested during the more active phases of birth. However, if a rest break is needed at such a time when you are in need of continuous professional support, I may need to call in a colleague at some point to relieve me for a sleep break.

REFUNDS

Refunds will be given under the following conditions:

100 % of the total fee will be refunded

• if services are cancelled before the beginning of the second trimester

• in the extremely unlikely event neither myself nor a colleague was reachable or available to attend your birth. *This is an exceedingly unlikely scenario, myself and my practice partners/colleagues always have many contingency plans in place to ensure the availability of support to you*.  NOTE: This does not apply if you choose not to have a back-up attend your birth, or if the myself or a partnering colleague misses the birth due to conditions stated in the next section.

Refunds are NOT applicable under the following conditions:

• If myself or my backup is unable to attend your birth due to your or your partner's failure to provide sufficient notice, or due to circumstances beyond anyone’s control (extremely fast labour, restrictions made by hospital, etc.), or if you choose not to have myself or a back-up provided by me attend.

• If you decline or fail to schedule a prenatal or postpartum visit with myself or a partner doula

PAYMENTS

Reminder that the equivalent of your deposit (50% total fee) is obtained to reserve your space in my calendar during your due window. In addition, part of this fee goes towards paying for my time working with you prenatally during our prenatal visits and phone / email contact and for my time spent being on-call for you leading up to your birth. A minimum of 50% of the total fee is due after our second prenatal visit. Unless other payment plans have been arranged, the full balance of the fee must be paid by the first of the month of your estimated due date.

MEDICAL ADVICE / ADVOCACY

While I am able to provide educational resources, information, and support, it is important to note that I am not a medical professional. It is always the client’s responsibility to consult a medical professional if they have medical concerns at any time or if they desire any medical tests, examinations, or advice.

When it comes to working with medical professionals or institutions, I will do my best to facilitate your right to informed decision making. However, it is not my role to protect you from your other chosen birth attendants or your chosen birth location. It is your responsibility to choose all birth attendants and your birth location according to your needs and birth philosophy. It is also not the my role to make decisions on your behalf. I can be present to support you in asking good questions, to help facilitate discussions with any chosen medical attendants, to remind you that you always have choice, and to support you / advocate for your right to make your own birth choices, but cannot make decisions on your behalf.

NOTE: By checking the “agree” box at the end of this intake form, you agree to the details laid out in my service agreement above.

Intake Form:

Name *
Name
Estimated Due Date *
Estimated Due Date
You have read and agree to the terms outlined in the Service Agreement *