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Home
About Momease
Contact Momease
Momease Products
Gift Cards
History
Policies
Press Room
Partners
Classes & Tours
Class Schedule
Child Birth Classes
Baby Care for the 1st Month Classes
DC Area Hospitals Prenatal Tours
Parenting Classes
Newborn to 1-year old Classes
Touch and Tone Classes
Payment Plans for Government Shutdown
Meet the Doulas
Client Intake Form
Labor Doula Packages
Postpartum Packages
Breastfeeding
Lactation Services
Breastfeeding Products and Pumps
Class Modifications
Instructors
Instructors
Labor Doula Instructors
Postpartum Doula
Resources
Blog and Birth Stories
Parent Resources
Instructor Resources
Evaluations
Class Evaluation
Evaluation of Labor Support
Evaluation of Postpartum Support
Reviews
Client Intake Form
Client Intake Form
Please select any of the following options that you are seeking:
Labor Doula
Student Doula
Postpartum Doula
Lactation Consultant
Private Childbirth Class
Postpartum
Brandi Smith
Amy Lentner
Nathalie Grolleman
Vanessa Hanible
Rebecca Gitter
Taiwo I Ajao (Tia)
Ariel Rubin
Click
HERE
to view instructor bios.
Labor
Carolyn Alexander
Ann Carter
Jen Charest
Lacy Hierwater
Vanessa Hanible
Jamie Mueller
Laura Tashijian
Shannon Serrano
Click
HERE
to view instructor bios.
Student Doula
Abiana Bey
Frances Devanbu
Ria Freeman
Marnesha Hall
Lauren Scheiderer
Click
HERE
to view instructor bios.
If seeking a Labour Doula
Not Sure
Yes
No
Momease experienced doulas will be assisted by a student doula for no extra fee. Would you like to have two doulas at your birth for no extra fee?
Which Labor Doula Package?
Customize
Full Service
Basic Hospital
Doula on Demand
Not Sure
Mother/Care Taker Information
Mother
Care Taker
Age
Due Date:
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darrussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
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Hungary
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India
Indonesia
Iran
Iraq
Ireland
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Israel
Italy
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Japan
Jersey
Jordan
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Kenya
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Kuwait
Kyrgyzstan
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Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
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Paraguay
Peru
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Pitcairn
Poland
Portugal
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Romania
Russia
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Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Work Phone
*
Cell Phone
*
Returning to Work?
No
Yes
Email
Occupation
Father/Partner Information
First
Last
Age
Taking time off from work?
No
Yes
Email
Occupation
How Long?
Cell Phone
*
Family Support Persons
Children? Ages? Pets?
Referred By
OB/GYN or Midwife Information
First
Last
Hospital Name
Phone
Complete the following information for Lactation or Postpartum Visit
Infant Information
First
Middle
Last
Gestational Age
DOB
Present Age
Born At
:
HH
MM
AM
PM
Home In
Hours
Days
Present Weight
Birth Weight
Pediatrician/HCP Information
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darrussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Upcoming Events
HypnoBirthing
March 21 @ 6:30 pm
-
9:30 pm
Fri-Sat: Weekend Childbirth Class
March 22 @ 6:30 pm
-
9:30 pm
Fri-Sat: Weekend Childbirth Class
March 23 @ 9:00 am
-
5:00 pm
Baby Care & Breastfeeding Basics Class
March 24 @ 9:00 am
-
12:00 pm
MedStar Georgetown Hospital Prenatal Tour
March 24 @ 12:00 pm
-
12:45 pm
View All Events
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