Book Doula Services

If you haven't already done so, please see what I provide here.  
Here is a copy of the Service Agreement*

Michelle Tyliakos
mt@crowningglorydoula.ca
778-855-4561


Name *
Name
Phone # *
Phone #
Guess Date *
Guess Date
Partner's Name (if you have one)
Partner's Name (if you have one)
Partner's Phone
Partner's Phone
Birth Information
If your current care provider isn't your first choice please state who would prefer.
Hospital or homebirth? And state if you are still deciding about location
Do you have additional care providers? (Chiropractor, Naturopath, Acupuncturist)
Are there any steps that you are taking to improve your nutritional Status?
What types of physical activity are you taking part in?
I have read The Service Agreement. (link above) *
a 50% Retainer is needed to reserve my Doula Services. The final payment is due on the first of your Due Month. I am open to different payment plans. Please share if you'd like to have an alternative payment plan. Payments can be etransfered to mt@crowningglorydoula.ca
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