Request a NAPS Postpartum Doula Referral

Name Name First Last
Phone Phone - ### - ### ####
Email
We will send doulas who match your criteria your first name, phone number and email so they can introduce themselves.

We will send doulas who match your criteria your first name, phone number and email so they can introduce themselves. Please do not send my contact information to the referred doulas. I will contact them on my own.

This information will not be used for any purpose other than allowing selected doulas to introduce themselves. We always exclude your last name and street address.
How do you prefer to be contacted by the referred doulas? Please check any that apply, unless you have opted out of doulas contacting you.

How do you prefer to be contacted by the referred doulas? Please check any that apply, unless you have opted out of doulas contacting you. Text Phone call Email

NAPS will email you the referred doulas contact information.
Some insurance companies or employer based benefit programs require a certified doula. Check the box below if you need certified doulas.

Some insurance companies or employer based benefit programs require a certified doula. Check the box below if you need certified doulas. Send me certified doulas only.

Some of our experienced doulas choose not to certify for a variety of reasons, others are either formally certified or working towards certification.
Address
City (and neighborhood, if applicable)

We are able to offer referrals to most areas within the Puget Sound region.
Zip code
How many babies will be in the home?

How many babies will be in the home? one two (twins) three or more
Are you requesting:

Are you requesting: Virtual Support In-person Support Both/Either
Are you looking for daytime, evening, or overnight support?

Are you looking for daytime, evening, or overnight support? Daytime Evening (typically 5pm-10pm) Overnight Weekends Not Sure

Please select all that apply
How many visits a week are you requesting?

You may not know how much support you need, and that's okay!
What is your approximate start date for your NAPS Doula?
Is there a pet in your home? Please specify what type of pet and if the pet will be in the same room as the doula at any time.

We ask this question as some of our doulas may be allergic to certain pets.
Additional Information: Is there any other information that would be helpful in finding you a doula?

Ex. special needs or preferences, special sibling or pet support, particular dates needed
Where did you hear about NAPS?
Date Received Date Received / MM / DD YYYY
Type of Contact

Type of Contact phone email both
Primary Request

Primary Request Referral-a family is given the names of NAPS Doulas Low cost- a family or professional is sent the "reduced rate" email template Parent inquiry- a parent or family member has questions about NAPS but does not receive referrals Professional inquiry-a birth professional has questions about NAPS but does not receive referrals Member inquiry- a member or potential member has questions about membership or training
Geographic Area

Geographic Area Snohomish County (Everett, Lake Stevens, Marysville, Mukilteo, Snohomish) South Snohomish County (Bothell Snohomish Co, Edmonds, Lynnwood, Mill Creek) North King (North of 85th, Greenlake to Shoreline, Lake Forest Park, Kenmore) Monroe Area (Duvall) Eastside (Bellevue, Kirkland, Mercer Island, Newcastle, Redmond) Eastside (Issaquah, North Bend, Sammamish, Snoqualmie) North Eastside (Bothell King Co., Woodinville, North of Kirkland) Seattle (Capitol Hill, Central District, Downtown, Leschi, Madison Park, Wedgewood, University District, All neighborhoods south of N 85th St) Seattle (Queen Anne, Magnolia, Ballard) West Seattle South Seattle (South of Sodo, Burien, Seatac, Renton, Tukwila) South King County (Along i-5, Federal Way, Des Moines, Fife) South King County (Along SR-167, Kent, Auburn, Covington) East Pierce County (Bonney Lake, Puyallup, South Hill, Spanaway) West Pierce (Lakewood, Joint Base Lewis-McChord, Tacoma) Peninsula (Bainbridge, Bremerton, Vashon) outside range
Date of followup Date of followup / MM / DD YYYY
Doula referred
Doula referred
Doula referred
Additional Doula referred
Referral Completed by:
Additional notes
Type the letters you see in the image below.