Provider Referral for a Subsidized Swedish Doula

This request form is for providers and referring clinics only. 

  • Before you submit a request for a subsidized Swedish doula, please note the following: 
  • By submitting this request, you are agreeing that you have had a conversation with this client and have confirmed that they would like to have a doula present at their birth or during their postpartum recovery. 
  • Subsidized Doula Services can only be provided to clients who have active Medicaid/Apple Care, please ensure that the client qualifies for subsidized care before submitting this request. 
  • We cannot guarantee doula availability or funding for this client. Submitting this request will send an email to the Swedish Doula Program administrative staff. If funding and doula availability is sufficient, we will contact the client directly with the information provided. 

Please fill in the client’s information below:

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