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Name

First Name

Last Name

Email

Where do you plan to deliver?

Name of hospital/birthing center or home birth

Estimated Due Date

the date your care provider is using

MM

DD

YYYY

Where in the NYC area do you live?

we need this to identify doulas that serve your neighborhood

Who is your OB/Midwife?

What level of experience are you looking for?

You can either let us know experience level or price range