Caregiver Doula Referrals

The following referral forms are for providers and caregivers only.

Perinatal Doula Referral Urgent Birth Doula Request Bereavement Support
Perinatal 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 prenatal and postpartum patients for community-funded doula care through our program.

Before you submit a request for a community-funded 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.
  • Community-Funded Doula Services can only be provided to clients who are actively enrolled in Medicaid/Molina/Apple Health.
  • 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 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 needed urgently for a patient admitted to Labor & Delivery

This request form is for caregivers to request a Birth Doula for a patient admitted to Labor and Delivery and who is in need of support now.

Before you submit a request for an urgent Swedish Birth 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 birth doula present.
  • Subsidized Birth Doula Services can only be provided to clients who have active Medicaid/Molina/Apple Health enrollment.
  • 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.

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 gifts from families who have had similar experiences.
  • 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.

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