This Certified Postpartum Doula Reference Form is designed for agencies, certification reviews, and care organizations that need reliable feedback from former clients, supervisors, healthcare providers, or professional peers. It helps standardize how references are collected so reviewers can assess a doula's experience, professionalism, and scope of postpartum support with more confidence.
The template covers key details such as the doula's name, known certification status, reference identity, relationship to the doula, contact information, service dates, hours of support, and care setting. It is especially useful when you need to evaluate work related to newborn care, breastfeeding support, maternal recovery assistance, and emotional support during the postpartum period.
You can adapt the form for certification programs, postpartum doula directories, hiring reviews, agency onboarding, or internal reference checks. Its focused structure helps reviewers compare professional references consistently while preserving space for detailed feedback about strengths, concerns, and family support experience.
