Caregiver Doula Referrals

The following referral forms are for providers and caregivers only.

Provider & Clinic Doula Referral Hospital Birth Doula Request Bereavement Support
Provider & Clinic Doula Referral
Refer your patient prenatally for Birth or Postpartum Doula care

This request form is for providers and referring clinics only, seeking to refer your patients for Birth or Postpartum Doula care through our program.

Before you submit a request for a 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.
  • Doula Services can only be provided at no cost to the client if they are actively enrolled in Medicaid/Molina/Apple Health.
  • We cannot guarantee Doula availability for this client. Submitting this request will send an email to the Swedish Doula Program administrative staff. If we have a and Doula available who matches the request, we will contact the client directly with the information provided.

Please note:

  • This form works best in Chrome and will sometimes not load in Internet Explorer.
  • This form sometimes takes a couple of minutes to load. We appreciate your patience.
Please fill in the client’s information below
A Birth Doula is for a patient admitted to either the Antepartum or Labor & Delivery unit

Before you submit a request for a Swedish Birth Doula for your patient, please note the following:

  • By submitting this request, you are agreeing that you have had a conversation with this patient and have confirmed that they would like to have a Birth Doula present.
  • Birth Doula Services can only be provided at no cost to clients who have active Medicaid/Molina/Apple Health enrollment. Exceptions may be made for clients who have compounding risk factors.
  • We cannot guarantee Doula availability. This request will be processed by our admin team and if the patient is eligible we will forward to our entire team of Swedish Birth Doulas. If a doula who meets this client’s preferences is available, they will contact you at the number provided.
  • If there is a positive match with a Birth Doula, it can take a few hours for the Birth Doula to arrive. If the patient is in active labor, we may not be able to get a Birth Doula there in time to support the birth experience.

Please note:

  • This form works best in Chrome and will sometimes not load in Internet Explorer.
  • This form sometimes takes a couple of minutes to load. We appreciate your patience.
Please fill in the client’s information below
For patients expecting the loss of a baby

This request form is for Bereavement Doula services for your patient who is experiencing loss, expecting their baby to die in utero or shortly after birth.

Before you submit a request for an urgent Swedish Bereavement Doula, please note the following:

  • This form is intended for providers, nurses, and other staff members. If you are a patient, please talk to your provider about being referred to this service.
  • Bereavement Doula care is free of charge for families; it is funded by our program, grants, and gifts from families who have had similar experiences and is not restricted to those with financial need.
  • Bereavement Doulas meet with the patient prior to the birth, attend their labor & delivery, and support them for one year after the birth takes place.
  • If you are requesting urgent Bereavement Doula support from the hospital, please note that it can be difficult for us to make a match urgently. Please submit the request and reach out to the Doula manager, Gwen, at 206-458-0620 to inquire about availability before offering services to the patient.

Please note:

  • This form works best in Chrome and will sometimes not load in Internet Explorer.
  • This form sometimes takes a couple of minutes to load. We appreciate your patience.
Please fill in the client’s information below