DOULA CLIENT AGREEMENT—POSTPARTUM - 20 hours
THIS AGREEMENT is made and entered into on the day of , 20 , by and between FULLMOONMAMA, a CT limited liability company, hereinafter referred to as the “Doula” or “I,” and , hereinafter referred to as the “Client” or “you.”
This is an agreement with FULLMOONMAMA, a CT limited liability company. This agreement is not with LAUREN GOMOLA personally.
1. Scope of Services
As your doula, I agree to provide non-medical physical, emotional, and informational support after the birth of your baby. I will help with self-care recovery, postpartum comfort measures, infant care, and parenting information, and will provide assistance with learning to feed and take care of your baby. I also will assist with breastfeeding (if desired). If something related to breastfeeding is beyond my scope, I can refer you to a lactation consultant.
My doula services will include preparing simple meals and snacks, getting drinks, and answering the phone and door, if desired. The tasks I provide each day will depend on the priorities discussed together before beginning services and on your particular needs that day.
Regarding overnight shifts - it is understood that I will be provided with a clean sleep space, I will sleep when the baby sleeps when the baby wakes I will care for the baby, or bring the baby to you as per your instruction.
I am happy to provide some basic food preparation and light housework, which may consist of laundry for you and your baby, sweeping, picking up toys, dusting in areas, and kitchen clean-up (such as emptying the dishwasher and wiping countertops). I do not do major housecleaning tasks, such as mopping, washing windows, or yard work.
I do not diagnose any medical conditions for you or your baby or give you medical advice. If you bring to my attention or if I notice anything of concern, I will refer you to an appropriate health care provider.
I do not transport you or your baby, although I am available to ride with you if you need me to accompany you. I do not take overall care of your baby. My goal is to help you become confident and secure in your own abilities as a new parent and family.
2. Duties and Responsibilities of Client
You acknowledge and agree that you are responsible for your own well-being and the well-being of your baby. As noted above, if you bring to my attention or if I notice anything of concern, I will refer you to an appropriate health care provider; it is your responsibility to follow-up as appropriate on my recommendations.
Prior to signing this agreement, I will disclose any potential scheduling difficulties I anticipate which may interfere with services. I serve clients on a first-come, first-served basis. You acknowledge that there are occasionally events which are unpredictable and which may affect dates of service previously agreed upon. In the event of illness or emergencies for either party or severe weather, every effort will be made to reschedule services at another time. If any payment for that day has already been made, it will be applied to future service.
My fee for the doula services to be provided is $670 total. At the time of signing this agreement, you agree to engage my doula services for 20 hours.
5. Refund; Terminating the Agreement
You have the right to terminate this agreement at any time.
Payments made or required under this agreement are subject to the following terms regarding refunds: Retainers are nonrefundable. Refunds are not provided if you choose not to have me provide the doula services after signing the agreement. If you terminate the agreement prior to provision of all hours agreed to in Section 4, payment of the outstanding balance is due and payable immediately.
I will maintain appropriate doula certification and insurance throughout the life of this agreement.
7. Grievance Policy; Mediation
I always strive to meet or exceed your expectations. If for any reason you are unsatisfied, I encourage you to communicate with me directly so that I may rectify the situation. You may also file a grievance with Bebo Mia if for any reason you want to speak privately with another doula regarding your concerns. They will do their best to assist you with your concerns and, if necessary, will contact me so that I may have the opportunity to offer a solution. If you are ever unsatisfied with how a grievance is handled, you may elect to solve the disagreement through mediation with a third-party mediator.
8. Release from Liability
You understand that I have a limited role pursuant to the description of services outlined above. You acknowledge and agree that I have not represented to you that contracting for my services guarantees in any way a risk-free or emergency-free postpartum experience. You acknowledge and understand that neither I nor the back-up doula (if applicable) make medical or nursing decisions on your behalf, including but not limited to the decision when to seek medical care at a hospital when postpartum support services are provided in your home. When services are performed in a medical facility, you acknowledge and agree that I am not responsible for the performance of clinical tasks including but not limited to medical or nursing decisions regarding the inclusion or exclusion of treatments available to you and your baby.
Now, therefore, in consideration of the above acknowledgements, you (both jointly and separately), on behalf of yourself, yourselves, and your heirs, administrators, personal representatives, executors, and assigns RELEASE AND FOREVER DISCHARGE me and the back-up doula from all damages or causes of actions, either at law or in equity, which you may have or acquire or which may accrue to you or your heirs, administrators, personal representatives, executors, or assigns as a result of using the doula services under the agreement. You intend this to be a COMPLETE RELEASE AND DISCHARGE as to me and the back-up doula from any and all liability whatsoever.
You acknowledge and agree you have read all statements contained herein and you fully realize that you are signing a COMPLETE RELEASE AND BAR to any claims which you have or believe you have resulting from our agreement for doula services.
If you, a member of your household, or myself become infected with COVID-19 all services will be postponed or offered virtually until the infected person(s) are deemed no longer contagious by a healthcare professional and has proof of a negative COVID-19 test.
*I agree to maintain weekly COVID-19 tests to ensure your family's safety.
This agreement constitutes the entire agreement between the parties relating to this subject matter and supersedes all prior or simultaneous representations, discussions, negotiations, and agreements, whether written or oral.
This agreement may be amended or modified only by written agreement of all parties, which shall include handwritten changes to the document in the presence of all parties as long as the handwritten change is initialed by all parties.
This agreement shall be construed in accordance with the laws of the State of Connecticut and the parties hereto agree that venue shall be in Fairfield County, CT.
If any dispute arises between the parties with respect to the matters covered by this Agreement which leads to a proceeding to resolve such dispute, the prevailing party in such proceeding shall be entitled to receive its reasonable attorney fees, expert witness fees, and out‑of‑pocket costs incurred in connection with such proceeding, in addition to any other relief to which it may be entitled.
IN WITNESS WHEREOF, the parties have executed this agreement on date written above.