Doula's Name *

First Name

Last Name

My doula respected my opinions and preferences for birth/parenting

Yes

No

n/a

My doula was attentive to and respectful of my partner's role

Yes

No

n/a

My doula was respectful of my care providers (nurses, midwives & doctors)

Yes

No

n/a

My doula was helpful to my birth partner

Yes

No

n/a

My doula was helpful to me

Yes

No

n/a

Are you the birthing partner or family member?

Yes

No

May we share some of this evaluation anonymously as a testimonial?

If we may use your words as a testimonial, please include your name, email and the current date below. You will be contacted to ensure your privacy is respected before publishing anything. We do not include full names in any mention of our clients.

Yes

No

Name

First Name

Last Name