------------------------ Register Now - The Birth Doula Program ------------------------

To register in our program please complete the following form. You will then be contacted to schedule an in-person consultation with one of our doulas to see if she’s a good fit for you. These sessions will be conducted in the comfort of your home. You won’t be charged for any service until and unless we find a doula you are comfortable with. We accept Visa/MC/Amex or etransfers for payments.

If you’re just looking for more info, use the contact form here instead.

Name:*

First

Last

E-mail:*

Partner's Name (if applicable):

First

Last

Address:*

Street AddressCityProvincePostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry

Phone:*

Area Code

-

Phone Number

Due Date:*

Where are you having your baby?:*

Markham Stouffville Midwifery Alongside Unit

Markham Stouffville (OB unit)

The Scarborough Network - General

The Scarborough Network - Birchmount

The Scarborough Network - Centennary

Which Program did you want to register for?:*

Training Program ($300)

Experienced Doula Program ($1050)

Unsure at this time

Doctor's name or midwife practice :*

Is this your first baby? If no, please list the number of previous births:*

Please tell us your age:*

Do you speak English? Please list other languages you speak:*

Do you want to Breastfeed your Baby?:*

Yes

No

Not sure

Do you have plans for the use of medications in labour? Please tell us your thoughts. It's ok if you aren't sure.:*

Do you have any health issues or cultural issues that we should know about? If so, please tell us so we can do our best to accommodate them:

I agree to the terms of service, including the cancellation policy found here: birthdoulaprogram.ca/terms-of-service*

Yes

No

Anything else you'd like to share with us:

SubmitReset

Recaptcha Word Verification: