Birth and Baby Services

Offering low-cost & no-cost birth doula services


Confidentiality/HIPAA Agreement

As part of your potential birth team, we will have access to some of your medical information and by checking the appropriate box in this form, you understand and allow us to ask about and hear about your past and current health, as well as during your labor, delivery & postpartum.

Confidentialty/HIPAA Agreement - Check box that applies*
The birthing client or parent(s) of the birthing client who is a minor, understand and acknowledge that BABS (Birth and Baby Services) and all doula's associated with BABS (Birth and Baby Services) will have access to the birthing clients medical history, past, present and during labor, after delivery and postpartum. The information obtained may be used for the purpose of doula education and or certification or (re)certification and may be shared with a certification committee and all doulas associated with BABS (Birth and Baby Services). In addition, all information obtained may be used to understand how to best support the birthing client.
This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Thank you for completing the Confidentiality and HIPPA form. We will add this to your file!