The Birth Education Center of San Diego
 
   Empowerment Through Education
858.254.9515
Disclaimer Form

Once your Disclaimer form is received, a doula questionnaire will be sent you so we can match you with the best possible doulas that fit your needs. Doulas are matched on a first come first served basis.

We look forward to working with you...
Contact Information
Fill this out FIRST

Please fill this out so we can get your
questions to you as soon as possible!

First Name:
Last Name:
Partner's full name::
Address Street 1:
Address Street 2:
City:
Zip Code:  (5 digits)
State:                            
Due Date::
Best Start or other birth location?:
Best Phone::
Email:
Comments:

You MUST fill both side of this page out or we will not have any contact information to send the doulas to you - please fill out BOTH the Contact Information AND Disclaimer Form -

Please fill out contact information FIRST...

Doula Referral Disclaimer Form

The Birth Education Center & Best Start Birth Center provide free referrals for doulas as a courtesy to you. Doulas are independent contractors and are not employees or affiliated with the birth centers. Accordingly, the Birth Education Center and Best Start Birth Centerwill not be responsible for your decision to hire a referred doula and will not be responsible for the actions or inactions of that doula. We do our best to match you with a doula but it is your choice to hire or not hire the doula suggested and your responsibility to choose the right doula for you.  

The Birth Education Center and Best Start Birth Center expressly disclaim all liability for your decision to hire or not hire a referred doula. Furthermore, the Birth Education Center and Best Start Birth Center make no claims, promises, warranties or guarantees about the abilities of any referred doula.

Under no circumstances shall the Birth Education Center and Best Start Birth Center be liable for any direct, indirect, incidental, special, punitive or consequential damages that result in any way from your decision to hire or not hire a referred doula or the actions or inactions
 of any referred doula.

Mother E-Signature: *
Partner E-Signature: *
Security Code: *  

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