The Mindful Match™

Doula Match Intake Questionnaire

Let's get to know you better! Please complete our intake form to help us find your perfect Doula match. If you're not comfortable with a question or two, no worries - simply answer n/a! But remember, the more you share, the better the match! Plan on about 7-10 minutes to complete the form.

A non-refundable payment of $25 is required to begin The Mindful Match™, our personalized doula matchmaking service. This amount will be credited toward your final invoice if you book with a Mindful Mommy Doula Services doula.

Thank you, and we look forward to finding your match!

- Gio Aiello, Founder, Mindful Mommy Doula

Step 1 of 7

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Let's start by gathering some basic details....

Name(Required)

First Last

Phone(Required)

Email(Required)

When is your due date / When was your baby born?(Required)

Month

Day

Year

Which of our doula services are you interested in?(Required)

Choose any of the options that apply

Birth Doula

Postpartum Doula

Night Doula

What are your pronouns?(Required)

What is your age?(Required)

Doula Match Fee & Insurance Coverage

Doula Matching Fee(Required)

Please Note: A non-refundable payment of $25 is required to begin The Mindful Match™, our personalized doula matchmaking service. This amount will be credited toward your final invoice if you book with a Mindful Mommy Doula Services doula.

Price:

Untitled(Required)

I understand that a non-refundable payment of $25 is required to begin The Mindful Match™ and that this payment covers the personalized matchmaking process.

Credit Card(Required)

Cardholder Name

Card Details

Address or Main intersections & City (the more specific, the better for matching!)(Required)

Street Address City Postal Code

Do you have insurance coverage?(Required)

If you have extended benefits or insurance for doula coverage, please let me know who you are insured under. Please Note: WE NEED TO KNOW IF YOU ARE USING INSURANCE BENEFITS. Choose any of the options that apply.

No Private Insurance Coverage

Sun Life (be sure to check if you specifically have Doula Coverage?)

Carrot Fertility Insurance

Other

If other, please specify your privacy insurance company and coverage.

If so, does your doula need to be certified with a specific agency for insurance purposes?(Required)

DONA

CAPPA

Doula Canada

ICEA

Birth Works International

Other

If your doula needs to be certified with another agency not listed above, please check "other" and let us know the details.

Doula Support - Let's get to know you better!

What is your knowledge level on Doulas and what they do? (Required)

I don't know anything about doulas or what they offer

I know very little about doulas and what they do

I am very familiar with doulas and the care they offer

I have hired a doula before

You have worked with a doula before! What was your experience like? What did you like or appreciate? Were there any aspects of the care that you didn't like or felt were missing? Please explain below: (Required)

Why do you want a doula? (Required)

Are you having ....(Required)

One baby

Twins

Triplets

More?!

What baby # is this?(Required)

1st baby

2nd baby

3rd baby

What are the ages of your other children at home?

Do you have a partner? (Required)

Single

In a Relationship

It's Complicated...

Do you have a language preference for your Doula? (Required)

Do you have an ethnicity preference for your Doula?(Required)

How is your pregnancy going so far? (if currently pregnant)(Required)

Choose any of the options that apply!

Easy, I love being pregnant!

I have some good days and I have some not so good days

Challenging

Based on your answer above, please explain in more detail (ie: health issues, mood etc)

Do you have a history of anxiety or depression? (Required)

Yes, I do

Sometimes

Not at all

If you sometimes or frequently experience anxiety or depression, please share a bit more here as you feel comfortable.

How will you plan on/do you feed your baby?(Required)

Breastfeeding

Bottle Feeding

Both

Whichever works!

How many Doulas would you like to be matched with? (This will be based on availability of the doulas as well)(Required)

Choose any of the options that apply

Two Doulas

Three Doulas

Four Doulas

Whatever you think is best for me

What communication style would you like from your Doula?(Required)

Straight Forward Speaking

Strong & Reserved

Other

Are you interested in any of our additional services?(Required)

Sleep Consulting

Placenta Encapsulation

Prenatal Consult

Craniosacral Therapy

Birth Doula Services

Birthing Location (Name of Hospital, Birth Centre, Home etc)

Who is your care provider for pregnancy and birth?

Do you have a partner? And will they be present at the birth with you?(Required)

Have you completed any fertility treatments to become pregnant?

We want to take into account every part of your journey. Please answer this question only if you feel comfortable.

Yes

If you would like to share or add anything about your pregnancy or upcoming birth, please do so below:

Are you currently experiencing anxiety or depression with this pregnancy?

Yes I am

Sometimes

Not at all

Please explain in more detail (if you are comfortable with it)

Doulas offer physical, emotional and information support during your pregnancy journey. Which one is the most important to you?(Required)

Information Support (I like to know my facts!)

Emotional Support (I would love reassurance & support)

Physical Support (help me manage my pain please!)

Are you looking for more of a "hands on" or "hands off" approach from a Doula?(Required)

Hands on! I love massage and touch

Only when necessary

Hands off! No thanks!

What kind of doula would you feel most comfortable with supporting you postpartum?(Required)

Choose any of the options that apply!

The "Mom" Type – Gentle and attentive, she's there to help you feel nurtured, lend a listening ear, and offer practical support as you adjust to life with a newborn.

The "Sister" Type – Fun and relatable, she brings a lighthearted approach, ready to swap stories, make you laugh, and keep things real during those early days.

The "Aunt" Type – Calm and wise, she provides a steady presence, offering advice when needed, helping you find balance, and bringing peace to your postpartum journey.

How will you be approaching pain management? (You do not have to know for sure at this point but it helps to give us a better idea!)(Required)

Epidural for sure!

Unsure, I want to wait until I am in the moment

I want a natural birth

Which care provider did you choose?(Required)

Obstetrician

Midwife

Why did you choose this care provider?(Required)

Postpartum Doula Services

$45/hour
Do you have a rough idea of how much help you may want? (This can change but it helps with the matching process). Most families like to start with the 12 hour package which can give you 4 shifts (at 3 hours each visit ) you can also create your own package of hours as well.

What kind of help are you looking for during postpartum?(Required)

Referrals to outside sources, ie: lactation consultants, pelvic floor etc)

Tips for soothing your baby

Emotional Support (Our fave!)

Colic

Postpartum depression and/or anxiety

Answer any questions that refer to you and your baby

Help with bathing and swaddling

How many times a week would you like care?(Required)

Choose any of the options that apply

1 day a week

2 days a week

3 days a week

4 days a week

5 days a week

Not sure yet!

Do you know how long you would like each shift to be? (This can change later if needed) The rate is $45/hr with a 3-hour minimum visit at a time,(Required)

How long would you like this support for? (Example: One week, 3 weeks, 2 months, etc...)(Required)

What kind of doula would you feel most comfortable with supporting you postpartum?(Required)

Choose any of the options that apply!

The "Mom" Type – Gentle and attentive, she's there to help you feel nurtured, lend a listening ear, and offer practical support as you adjust to life with a newborn.

The "Sister" Type – Fun and relatable, she brings a lighthearted approach, ready to swap stories, make you laugh, and keep things real during those early days.

The "Aunt" Type – Calm and wise, she provides a steady presence, offering advice when needed, helping you find balance, and bringing peace to your postpartum journey.

Night Doula Services

$360/Night for 8 hours ($45/hour)
Do you have a rough idea of how much help you may want? (This can change but it helps with the matching process). Each Night Doula shift is 8 hours in length (Ie: 10pm-6am). There is no minimum amount of nights that need to be booked, you can create your own package of hours.

What kind of help are you looking for during postpartum?(Required)

Referrals to outside sources, ie: lactation consultants, pelvic floor etc)

Tips for soothing your baby

Emotional Support (Our fave!)

Colic

Postpartum depression and/or anxiety

Answer any questions that refer to you and your baby

Help with bathing and swaddling

How many times a week would you like overnight care?(Required)

Choose any of the options that apply

1 day a week

2 days a week

3 days a week

4 days a week

5 days a week

Not sure yet!

How long would you like this support for? (Example: One week, 3 weeks, 2 months, etc...)(Required)

What kind of doula would you feel most comfortable with supporting you postpartum?(Required)

Choose any of the options that apply!

The "Mom" Type – Gentle and attentive, she's there to help you feel nurtured, lend a listening ear, and offer practical support as you adjust to life with a newborn.

The "Sister" Type – Fun and relatable, she brings a lighthearted approach, ready to swap stories, make you laugh, and keep things real during those early days.

The "Aunt" Type – Calm and wise, she provides a steady presence, offering advice when needed, helping you find balance, and bringing peace to your postpartum journey.

Let's get to know your style & personality

What is your favourite vacation destination?(Required)

Beach

Mountains

Cross Country Road Trip

Camping

What was your favourite game when you were a child?(Required)

Hide and Seek

Sports

Board Games

Puzzles

Playing alone

If asked, what would your friends and family say about you?(Required)

Kind

Smart

Caring

Quiet

Would you rather read a book or watch television?(Required)

Book

Television

Do you think you are an introvert or an extrovert? And why?(Required)

Let's get to know your lifestyle...

Do you consider your lifestyle to be more naturally based ?(Required)

Yes, the more natural the better!

Somewhere in the middle

Nope

What do you consider yourself?(Required)

Spiritual

Religous

Atheist

Are you a fan of essential oils?(Required)

Oh yeah!

I use them once in awhile

No, too woo-woo for me!

What is your favourite form of exercise?(Required)

Yoga/Meditation

Weights

Running

Do you have any pets? (We want to ensure we find a Doula that loves pets too!)(Required)

Dog

Cat

Nope

Is there anything else you'd like us to consider as we find create your Mindful Match™?(Required)

Did anyone refer you to Mindful Mommy? (ie: another doula?) Please write their name below.(Required)

Your The Mindful Match™ Fee of $25 will process once you click FIND MY MATCH!

The Mindful Match™

Doula Match Intake Questionnaire

Let's start by gathering some basic details....

Doula Match Fee & Insurance Coverage

Doula Support - Let's get to know you better!

Birth Doula Services

Postpartum Doula Services

Night Doula Services

Let's get to know your style & personality

Let's get to know your lifestyle...

Monday 9:30-4:00pm

Tuesday 9:30-4:00pm

Wednesday 9:30-4:00pm

Thursday 9:30-4:00pm

Friday 9:30-4:00pm

Saturday CLOSED

Sunday CLOSED

Please allow 24 hours for your Doula matches to be sent. If you have submitted to Find Your Match on a CLOSED day, we will start your matching the next business day!

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“Imagine a world where Mother's feels empowered, supported, and understood. Welcome to that world.”