Please use this form to contact Melissa with general inquiries, or to check availability for doula support for late referrals.

If you would like to request doula service for yourself or a client (prior to 32 weeks pregnant, unless otherwise indicated) please do not use the form below. Instead complete one of the following:

Medicaid Insurance Plans: complete this formPrivate Insurance Plans (received through an employer or purchased as an individual/family) complete this form.

Note: Melissa's office hours are Tuesday, Wednesday and Thursday, 9 a.m. to 3 p.m. Replies will be sent during these times.

Name *
If you are inquiring about doula support for yourself or a client, please make sure you include the following information: estimated due date, type of insurance (private or Medicaid) and birthing location.
Do you understand that all doula requests will also need to have a completed referral form? This form can be found at: