Birth / Postpartum Client

POSTPARTUM SUPPORT REQUEST

Full name *

Please provide your full name.

Email *

Please provide your email address.

Phone *

Please provide your phone number.

Partner Name *

Please provide your partner's full name.

Partner Email *

Please provide your partner's email.

Partner Phone *

Please provide your partner's phone number.

Street address *

City *

State *

Zip / Postal Code *

Job position *

Estimated Due Date *

Do you plan to breastfeed?

Please describe your pregnancy so far.

What is your hourly budget? *

We are a collective of postpartum caregivers. Rates begin at $50/hour for night nannies (this service not covered by insurance) and begin at $65/hour for postpartum doulas.

Do you plan to use Carrot benefits?

How many hours per night do you request?

8H (10pm-6am) / 10H (8pm-6am) / 12H (6pm-6am or 7pm-7am)

What is your preferred schedule for postpartum care, outlined week by week?

Do you plan to be receiving support from your partner, family, friends, or other community?

Do you have any postpartum traditions you’d like to honor?

Who lives in your home with you, including pets?

Birth parent: How would you describe your general mental and emotional baseline? Are there any supports, practices, or care you currently have in place for your mental health?

What kind of support feels most helpful to you right now? *

Prioritizing rest while you handle the night Guidance and education so we can feel confident doing this on our own Support with feeding (breastfeeding, pumping, or bottle) A mix of everything, depending on what comes up Not sure yet

What helps you and your partner feel calm, comfortable, and at ease when someone is caring for your baby in your home? Are there any behaviors, habits, communication styles, or household preferences that may cause stress or frustration that would be helpful for your doula to know in advance?

What would a successful night with your doula look like for you?

Please describe what you would ideally like to happen from the beginning of the shift through the morning.

What would you like the doula to handle independently overnight? For example: diaper changes, soothing, bottle feeding, burping, settling baby, preparing bottles, washing/sterilizing feeding supplies, tracking feeds and diapers, baby laundry, etc.

When would you like the doula to wake or involve a parent overnight? Please be specific about feeding, pumping, breastfeeding, prolonged crying, health concerns, or anything else you would want to be notified about.

What is your current feeding plan? Please include breastfeeding, pumping, formula, bottles, feeding frequency, and any preferences or challenges you are currently experiencing.

What are your expectations when baby is sleeping? For example: doula may rest when baby rests after responsibilities are completed, remain awake throughout the shift, complete baby-related tasks, prepare for the next feeding, etc.

Are there any baby-related household duties you expect during the shift? Please list anything you would like included, such as bottles, pump parts, sterilizing, baby laundry, nursery organization, restocking, or preparing feeding stations.

What communication style works best for your family? For example: detailed overnight log, brief morning recap, text updates overnight, minimal communication unless needed, collaborative suggestions, or following an established plan closely.

Are there any household, cultural, religious, dietary, privacy, or personal preferences that would be helpful for your doula to know in advance?

What qualities are most important to you in your next doula? For example: calm, nurturing, highly experienced, proactive, discreet, communicative, structured, flexible, lactation knowledgeable, confident working independently, etc.

Is there anything else you or your partner would like me to know before I begin identifying potential candidates?