Contact 1 — Maine Doulas

Independent Contractor Invoice

If your invoice includes birth support, please complete the Birth Support Debrief below, in addition to the invoice.

INVOICE

Your Name

First Name

Last Name

Your Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

This Invoice is for the Week Ending (Sun)

MM

DD

YYYY

Client Full Name

Date of Service

MM

DD

YYYY

Service Performed

Indicate birth, prenatal meeting, postpartum, etc

If Postpartum, Total Hours

Client Full Name

Date of Service

MM

DD

YYYY

Service Performed

Indicate birth, prenatal meeting, postpartum, etc

If Postpartum, Total Hours

Client Full Name

Date of Service

MM

DD

YYYY

Service Performed

Indicate birth, prenatal meeting, postpartum, etc

If Postpartum, Total Hours

Client Full Name

Date of Service

MM

DD

YYYY

Service Performed

Indicate birth, prenatal meeting, postpartum, etc

If Postpartum, Total Hours

Client Full Name

Date of Service

MM

DD

YYYY

Service Performed

Indicate birth, prenatal meeting, postpartum, etc

If Postpartum, Total Hours

Client Full Name

Date of Service

MM

DD

YYYY

Service Performed

Indicate birth, prenatal meeting, postpartum, etc

If Postpartum, Total Hours

Client Full Name

Date of Service

MM

DD

YYYY

Service Performed

Indicate birth, prenatal meeting, postpartum, etc

If Postpartum, Total Hours

Any pre-authorized extended travel?

Please note any preauthorized travel time beyond standard area of care

Do you have anything of note to share about your client experiences this week?

BIRTH SUPPORT DEBRIEF

Please complete this form when your invoice includes birth support. This is in addition to the invoice above.

Doulas Name

First Name

Last Name

Client Name

First Name

Last Name

What day did you join the labouring client?

MM

DD

YYYY

Approx Arrival Time

About what time did you join the client? (Choose AM/PM)

Hour

Minute

Second

What day did you leave the client postpartum?

MM

DD

YYYY

Approx Departure Time

About what time did you leave the client postpartum? (Choose AM/PM)

Hour

Minute

Second

Birth Date

MM

DD

YYYY

Approx Birth Time (Choose AM/PM)

Hour

Minute

Second

Who do you remember being there?

Partner, nurses, residents, doctors, midwives. Please share their names, if you remember

Baby's Name or Names

Please share what you can remember about the progression of labour, the birth parent's coping strategy, the partner's participation, and the like

What did you learn from this birth?

About yourself as a doula, about the provider, about birth, etc.

What are you most proud of in your support of this family?

Please share any other notable details about this birth

Follow up visit scheduled?

Yes

No