Membership Questionnaire

NAPS Doulas wants to learn more about you! Please update this any time your information changes or when you recertify with NAPS.

Most of these questions are optional. These answers are used to better understand our current membership, better serve you as members, and understand where our potential areas of growth are. We appreciate your participation!

This section is optional and can be updated at your convenience.
Please share your other perinatal professions & skills.

First Name *

Last Name *

Pronouns

no preference

he/his

she/hers

they/theirs

(ask me)

(she/they/theirs)

Phone 1

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Date of Postpartum Doula Training (if applicable)

Date of Birth Doula Training (if applicable)

Have you served clients? *

Yes

Number of Families Served

Postpartum Doula Rate (if applicable)

Not Currently Practicing

$30-$34

$35-$39

$40-$49

$50-$59

$60-$69

$70+

Other

Birth Doula Rate (if applicable)

$600-$800

$900-$1100

$1200-$1400

$1500-$1700

$1800-$2000

$2100-$2300

$2400+

Other

Reason for joining NAPS *

Support You Need

What support do you need to be successful in your doula work? What would you like from your mentorship experience?

Favorite hobbies

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Age Range

Teens

20-29

30-39

40-49

50-59

60-69

70+

Sexual Orientation

Religious Affiliation

Racial/Ethnic identity

American Indian/Alaskan Native

Asian

Black/African American

Hispanic/Latino or Spanish

Native Hawaiian or Other Pacific Islander

Non-Hispanic White or Euro American

Multi-racial/Multiple Ethnicities

Other

The categories are based on the US 2020 Census Briefs. Mark any that apply. If you do not see your specific race or ethnicity listed, please list in Other box.

Languages

What languages do you speak other than English?

Access Needs

Dietary

Allergies

Visual/Hearing

Language

Mobility/Comfort

Cultural/Religious Calendar

Financial

Transportation/Location

Access to Internet

Avoiding events with alcohol

Access to childcare

COVID

Immunocompromised

Other

Please let us know any barriers that may limit your participation at events

Access Needs Clarification

Please detail any of the above needs, if needed

Identity Privileges - In the spirit of ongoing dialog and learning around privilege and implicit bias, please share with us any identity privileges you feel like you have or don't have. *

Examples: White/White-Passing, Cis-gendered, Able-bodied, Heterosexual, Marriage, Dual-income family, Car Access, Middle or Upper Class, Neurotypical etc. For more context, please see: https://therumpus.net/2012/05/peculiar-benefits/

NAPS Alliance For Social Equity (NASE)

Comments, questions, concerns for the NASE Committee in our work towards social equity for our organization and in particular, our membership

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Other Perinatal Professions

Postpartum Doula

Birth Doula

Abortion Doula

Adoptive Families/Surrogacy

Belly Binding

Bereavement Doula

Bringing Baby Home

Certified Nursing Assistant

Childbirth Educator

Child Passenger Safety Technition

Death Doula

Fertility Doula

Full Spectrum Doula

Hypnobirthing

IBCLC

Incarcerated Parent Support

Infant Massage Therapy

Lactation Educator

Lactation Peer Counselor

Multiples Support

Newborn Care Specialist

NICU/Prematurity/Medically Fragile Support

Occupational Therapy

Pediatric Sleep Consultant

Perinatal Massage Therapy

Perinatal Mental Health Peer Counselor

Perinatal Nutrition Advisor

Perinatal Yoga Instructor

Placenta Encapsulator

Prenatal Support

Substance Use Disorder Support

TENS Unit

Trans Parent Support

Trauma Informed Care

Vaginal Steaming

What other perinatal services can you provide?

Abortion Support

Adoptive Families/Surrogacy

Bereavement/Grief/Loss/Miscarriage

Birth/Labor Support

Family Planning/Contraception

Incarcerated Parents

Multiples

Perinatal Nutrition

Placenta Encapsulation

Premature/Medically Fragile/NICU

Prenatal Support

Substance Use Disorder

Trans Parents

Trauma Informed Care

Other Relevant Experience

Do you have Business Marketing experience to share? Please describe.

Have an account? Log in

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.