About this template
Establishing clear terms, boundaries, and mutual understanding is essential for any professional birth support relationship. The Virtual Birth Doula Agreement Form is designed for independent doulas and wellness practitioners to onboard expectant mothers, outline the exact scope of virtual support, and secure legally binding acknowledgments before care begins. This comprehensive template collects vital client information, pregnancy milestones, planned delivery locations, communication preferences, and specific service packages.
By using Doc2Form to deploy this template as a Google Form, practitioners can easily customize service offerings, collect electronic signatures or acknowledgments, and maintain organized records in Google Sheets. It eliminates administrative friction, protects both the practitioner and the client by clarifying service limitations, and ensures that all expectations regarding prenatal, labor, and postpartum virtual support are aligned from day one.
Key features
- Capture complete client and partner contact details in one step.
- Collect estimated due dates and planned birth locations accurately.
- Allow clients to select from multiple virtual support packages.
- Secure formal acknowledgment of terms, policies, and service limits.
- Integrate seamlessly with Google Sheets for effortless client tracking.
Use cases
Onboarding new clients for virtual prenatal and postpartum coaching s…
Onboarding new clients for virtual prenatal and postpartum coaching sessions.
Securing signed service agreements and package selections prior to la…
Securing signed service agreements and package selections prior to labor support.
Documenting client communication preferences and emergency contact de…
Documenting client communication preferences and emergency contact details.
What this form collects
- Agreement Date (Date)Today's date.
- Mother's Full Name (Short answer)Enter your first and last name.
- Mother's Age (Short answer)Enter your current age.
- Mother's Date of Birth (Date)Select your birth date.
- Email Address (Short answer)Where we can send resources, session links, and scheduling updates.
- Phone Number (Short answer)Primary mobile number for calls, texts, and messaging apps.
- Partner's Full Name (if applicable) (Short answer)Enter your partner's name if they will be participating in sessions.
- Partner's Contact Information (Paragraph)Email and phone number for your partner.
- Estimated Due Date (Date)Your expected baby arrival date.
- Planned Birth Location (Short answer)Hospital, birth center, or home birth location.
- Preferred Communication Method (Multiple choice)How you prefer to connect for virtual check-ins and support.
- Select Available Package (Dropdown)Choose the virtual doula service package that best fits your needs.
- Preferred Payment Method (Multiple choice)Select how you plan to settle service invoices.
- Comments, Suggestions, or Feedback (Paragraph)Share any specific preferences, birth plan details, or questions you have for your doula.
- Terms and Conditions Acceptance (Multiple choice)Please confirm that you have read and agree to the scope of service, fees, and privacy policies.
- Mother's Signature (Short answer)Please type your full legal name as an electronic signature to authorize this agreement.
- Date Signed (Date)Today's date for signature verification.
FAQ
What is a virtual birth doula agreement form?
It is a contract and intake document used by doulas to outline the scope of their virtual support, establish terms of service, and collect necessary client and pregnancy details.
Can I customize the service packages in this template?
Yes! Once converted to a Google Form via Doc2Form, you can fully edit, add, or remove package options to match your exact pricing and service tiers.
How does Doc2Form help me use this template?
Doc2Form instantly transforms this document layout into a ready-to-use Google Form in your Google Drive, saving you hours of manual form building.
Is this form suitable for remote or virtual doula services?
Yes, it specifically includes fields for virtual communication methods, remote check-ins, and digital terms acceptance tailored to online doula practices.
Where are my client responses stored?
All submissions are saved directly to a Google Sheet linked to your Google Form, keeping your client data secure and organized in your personal Drive.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.