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Doula
Breastfeeding
- Benefits Of Breastfeeding
- Breastfeeding Products and Pumps
Cancel or Modify Reservations
Instructors
Resources
Evaluations
Momease Partners
- Placenta Encapsulation

Home
Classes & Tours
Doula
Breastfeeding
- Benefits Of Breastfeeding
- Breastfeeding Products and Pumps
Cancel or Modify Reservations
Instructors
Resources
Evaluations
Momease Partners
- Placenta Encapsulation

Client Intake Form

Client Intake Form

Please select any of the following options that you are seeking:
- Personalized Labor Doula
- Team Doula
- Student Doula
- Postpartum Doula
- Lactation Consultant
- Private Childbirth Class
- Placenta Encapsulation
Labor Doulas
- Personalized Doula: Carolyn Alexander
- Personalized Doula: Shannon Serrano
- Personalized Doula: Jennifer Zaetler
- Personalized Doula: Vanessa Hannibal
- Personalized Doula: Kim Stinger
- Personalized Doula: Chaya Eaddy
- Personalized Doula: Shante Ferguson
- Personalized Doula: Amanda Coles
- Personalized Doula: Lacy Hierwater
- Team Doula: Janna Martin
- Team Doula: Akilah Witherspoon
Click HERE to view instructor bios.
Postpartum Doulas
- Vanessa Hanible
- Janna Martin
- Abiana Patton-Toure
- Akilah Witherspoon
Click HERE to view instructor bios.
Student Doula
- Amanda Copeland
- Tieya Qualls
- Regina Jenkins
Click HERE to view instructor bios.
Placenta Encapsulation
- Kim Stinger
- Akilah Witherspoon
- Chaya Eaddy
If Seeking a Labor Doula, Can a Student Doula Provide Additional Support?
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?/ Which Service*
Please identify which service/services you are interested in. We look forward to following up to begin the discussion of how we can meet your needs.
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 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
Please describe your need for a visit.
Present Weight
Birth Weight
Pediatrician/HCP Information
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Updates on Coronavirus

Upcoming Events

Fri & Sat Weekend Childbirth Class

September 30 @ 6:30 pm - 9:30 pm
Infant & Child CPR Group Class

September 30 @ 6:30 pm - 9:30 pm
Fri & Sat Weekend Childbirth Class

October 1 @ 9:00 am - 5:00 pm
Baby Care and Breastfeeding Basics

October 1 @ 1:30 pm - 4:30 pm
Infant & Child CPR Group Class

October 2 @ 9:30 am - 12:00 pm

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Upcoming Events

Fri & Sat Weekend Childbirth Class

September 30 @ 6:30 pm - 9:30 pm
Infant & Child CPR Group Class

September 30 @ 6:30 pm - 9:30 pm
Fri & Sat Weekend Childbirth Class

October 1 @ 9:00 am - 5:00 pm
Baby Care and Breastfeeding Basics

October 1 @ 1:30 pm - 4:30 pm
Infant & Child CPR Group Class

October 2 @ 9:30 am - 12:00 pm

View All Events

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Contact Us

Office: (720)-948-6923

After Hours: (720)-948-6923

211 North Union, Suite 100

Alexandria, VA 22314

calexander@momease.com
reginaj@momease.com

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