Request a NAPS On-Call Doula Referral

Please use this form if you are seeking a birth doula or postpartum doula to provide on call support while in the hospital after birth, immediate post-birth support at home and/or for care of siblings while you are giving birth.

Birth Doula Support: A birth doula provides continuous physical and emotional support during labor and may offer prenatal and postnatal visits.

Immediate Post-Birth Support: If you are not hiring a birth doula consider having immediate postpartum support to assist with feeding, baby care, and recovery after birth.

Sibling Doula Support:
A sibling doula would be on-call for your birth, to care for your other children, and assist in preparing them for the arrival of their new sibling(s).

Name Name First Last
Email
We will send doulas who match your criteria your first name and email so they may send you an introductory email.

We will send doulas who match your criteria your first name and email so they may send you an introductory email. I would not like an introductory email from doulas and would like to opt out of giving the referred doulas my email address. I will contact them on my own.

This information will not be used for any purpose other than allowing selected doulas to send you an introductory email. We always exclude your last name, street address and phone number.
Are you requesting:

Are you requesting: Birth Support Immediate Post-Birth Support Sibling Support

If you are requesting more than one, please fill out all relevant sections of this form
What is your due date?
Birth & Immediate Post Birth Support
Where will you be giving birth?

Where will you be giving birth? Birth Center Home Hospital
Birth Place Name

For Birth Center or Hospital
City

We are able to offer referrals to most areas within the Puget Sound region
Zip Code
Is your birth location more than 15 miles from your home?
Does your birth location require a ferry ride?
Sibling Support
(During Birth)

Fill out this section only if you are seeking sibling care in your home while during your labor, birth or postpartum recovery
How many older siblings will be in the home?

How many older siblings will be in the home? One Two Three or more
City and neighborhood

We are able to offer referrals to most areas within the Puget Sound region
Zip Code
Additional Information: Is there any other information that would be helpful in finding you a doula? (special needs or preferences, pet support, particular dates needed)
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.
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 Parent Inquiry - family isn't given the names of NAPS doulas
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 (Vashon, Bainbridge, Bremerton) Outside range

Please fill this out for all types of support
Date of Followup Date of Followup / MM / DD YYYY
Doula Referred
Doula Referred
Doula Referred
Referral Completed By
Additional Notes
Type the letters you see in the image below.

Request a NAPS On-Call Doula Referral

Request a NAPS On-Call Doula Referral

Birth & Immediate Post Birth Support

Sibling Support (During Birth)

Sibling Support
(During Birth)