Fox & Cub Doula Certification Form

Please complete this form to share your qualifications, certifications, and professional experience. This information helps ensure Fox & Cub maintains the highest standards of care and exceptional service for our private-pay clients, health plans, and insurance partners.
Are you Trust Line Certified?  If yes, upload the certification below. *
Maximum file size: 100 MB
Maximum file size: 100 MB
Maximum file size: 100 MB
Are you CPR certified from from the American Red Cross (ARC) or American Heart Association (AHA)?*If you are not, here is a link to get it done: https://www.redcross.org/local/california/take-a-class/cpr
Maximum file size: 100 MB
Do you have HIPAA training certification? *
If you do not have HIPAA Training, please complete the course by completing this FREE course: https://www.nephtc.org/enrol/index.php?id=178
Maximum file size: 100 MB
What are your specialties? Please list all of them *
Maximum file size: 100 MB
If you are not Medi-Cal approved, would you like assistance in getting Medi-Cal approved? *
Maximum file size: 100 MB
Maximum file size: 100 MB
What type of doula care do you offer (check all that apply) *
Maximum file size: 100 MB
How do you prefer to engage with your patients? (Check all that apply) *
Will you support clients & patients IN-PERSON during labor + delivery *
Are you on the Carrot directory? *
Are you comfortable encouraging vaccinations for both mom, child, and family members? We encourage and educate patients to stay up to date on their vaccinations so want to understand if you are aligned with our mission. *
What months are you available to take on patients? *
Maximum file size: 100 MB

This page will refresh after submit. If you scroll to the bottom of the page afterwards you will see the green button showing it has been submitted.

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Fox & Cub Family Wellness © 2025 All Rights Reserved.

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Fox & Cub Doula Certification Form

Please complete this form to share your qualifications, certifications, and professional experience. This information helps ensure Fox & Cub maintains the highest standards of care and exceptional service for our private-pay clients, health plans, and insurance partners.
Are you Trust Line Certified?  If yes, upload the certification below. *
Maximum file size: 100 MB
Maximum file size: 100 MB
Maximum file size: 100 MB
Are you CPR certified from from the American Red Cross (ARC) or American Heart Association (AHA)?*If you are not, here is a link to get it done: https://www.redcross.org/local/california/take-a-class/cpr
Maximum file size: 100 MB
Do you have HIPAA training certification? *
If you do not have HIPAA Training, please complete the course by completing this FREE course: https://www.nephtc.org/enrol/index.php?id=178
Maximum file size: 100 MB
What are your specialties? Please list all of them *
Maximum file size: 100 MB
If you are not Medi-Cal approved, would you like assistance in getting Medi-Cal approved? *
Maximum file size: 100 MB
Maximum file size: 100 MB
What type of doula care do you offer (check all that apply) *
Maximum file size: 100 MB
How do you prefer to engage with your patients? (Check all that apply) *
Will you support clients & patients IN-PERSON during labor + delivery *
Are you on the Carrot directory? *
Are you comfortable encouraging vaccinations for both mom, child, and family members? We encourage and educate patients to stay up to date on their vaccinations so want to understand if you are aligned with our mission. *
What months are you available to take on patients? *
Maximum file size: 100 MB

This page will refresh after submit. If you scroll to the bottom of the page afterwards you will see the green button showing it has been submitted.

Fox & Cub Family Wellness Logo
Get Support

Main Navigation

Help & Support

Company & Legal

Fox & Cub Family Wellness © 2025 All Rights Reserved.

Powered by K2 Website Design, Santa Rosa, Sonoma County, CA.

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