Start Eligibility + Intake Request
For families ready to begin care — this form starts your insurance verification and intake process.
If you’re just exploring options, please review What You Should Know Before Hiring Me first.
⚠️ Important: Please Read Before Submitting
Golden Soleil Doula Services provides:
- Prenatal support
- Virtual birth support during labor
- Postpartum support
🚫 I do not provide in-person labor or delivery support.
Birth support is offered virtually only (via text, phone calls, and real-time guidance).
Please continue only if virtual birth support works for you and your family.
Who This Form Is For (and Who It’s Not)
✅ This form is for families who:
- Are ready to begin care now.
- Can complete insurance verification or self-pay details.
- Understand and are comfortable with virtual birth support (no in-person labor support)
- Are open to completing the short intake and consent process.
- Value a calm, personal approach and ongoing communication.
🚫 This form is not for families who:
- Are looking for a doula to be physically present at the hospital or birth center
- Are still comparing doulas or requesting quotes.
- Want a discovery call or general information only.
- Are not yet ready to begin care or submit insurance info.
If you’re still learning about doula care, please visit What You Should Know Before Hiring Me or text me with questions before submitting.
Insurance Verification (if using health coverage)
If you plan to use Medi-Cal, Kaiser, or another health plan, I’ll verify your coverage before we begin.
Please upload the following details — all information is confidential and used only for verification:
- 📸 A photo of your insurance card (front side)
- 🧾 Your full legal name (as shown on the card)
- 🎂 Your date of birth (MM/DD/YYYY)
- 🩺 Your insurance member ID
🔒 All information is kept confidential and used only to confirm coverage.
💛 To honor both your time and mine, I only schedule intakes once insurance info is submitted (if you plan to use coverage). This way, we can focus on you during our call
What Happens Next
- Submit This Form: Completing this form means you’ve chosen to begin care with me.
- Email Confirmation: You’ll receive an email with a short video introduction and instructions to reply with “Yes, I’m ready to begin care.”
- Insurance Verification: Once you reply, I’ll verify your insurance coverage.
- Schedule Intake: After verification, I’ll contact you to schedule your intake appointment.
- Begin Doula Care: After intake, we officially begin care and stay connected through pregnancy, virtual birth support, and postpartum.
Because I give each family my full attention, I accept only 2–3 clients per month. If you’d like me to hold your due date, please complete the form below.
Required acknowledgment (checkbox)
Before we begin, please confirm:
Contact form submission
Serving the Greater Bay Area
Call or Text Me:
(925) 238-3042
Email:
Hours of Availability:
- Monday – Friday: 9 AM – 6 PM
- Weekends: By Appointment
Certified Doula | Medi-Cal Approved
Background Check Verified
