This agreement is entered into by and between Adrienne Bullock, doing business as Adrienne's Love, hereafter referred to as “Doula,” and the undersigned Client, hereafter referred to as “Client.”
1. Services Provided
The Doula agrees to provide doula services to the Client in accordance with Cradle Cincinnati program guidelines. Services include:
No-Call/No-Show Policy:If the Client has a no-call/no-show for a scheduled in-person prenatal visit, all remaining prenatal visits will be conducted virtually only.
2. Program Coverage
Cradle Cincinnati covers payment for approved doula services provided under this agreement. The Client confirms they are participating in the Cradle Cincinnati program and understands that only services authorized by the program are eligible for payment.
3. Consent for Program Participation
The Client authorizes the Doula to provide any documentation or visit verification required by Cradle Cincinnati. The Client agrees to respond to communication, complete required forms, and follow program guidelines to maintain eligibility.
4. Scheduling, Attendance, and Missed Visits
The Client agrees to communicate promptly to schedule prenatal, labor, and postpartum visits.
The Client must notify the Doula at least 24 hours in advance when unable to attend a scheduled visit.
No-call/no-show:If the Client does not attend a scheduled in-person prenatal visit and does not notify the Doula, remaining prenatal visits will be virtual only.
5. Duration and Termination
Either party may terminate this Agreement with written notice. Only completed, documented visits will be reported to Cradle Cincinnati for payment.
6. Confidentiality
Both parties agree to maintain the confidentiality of all personal, medical, and sensitive information shared during the course of services, in accordance with HIPAA and professional ethical standards.
7. Signatures
By signing below, both parties acknowledge and agree to the terms outlined in this Agreement.
Adrienne BullockDoula, Adrienne’s Love
