Urban Baby Beginnings Community Cares

Locality *

Who can be referred?

Any prenatal individual/family located in the Tri-Cities, Greater Richmond, and Hampton Roads area can participate.

Due date less than 7 weeks away and you need a Doula? Please contact our office to discuss your options by calling (833) 782-2229.

Please do not submit requests for diapers here.

Who will benefit most?

Any birthing individual will benefit from our services
Clients looking for Doula support
Expecting people who are at risk for preterm birth
Families who need breastfeeding help
Those looking to expand their birth knowledge through classes and in-home visitation
People who have limited financial resources
Birthing persons who are high risk due to health-related or psychosocial factors

What is the cost?

Our services are generally free if you qualify under one of our programs. If you do not qualify, sliding scale fees are available.

We currently accept certain Medicaid plans. Members of these plans may be covered 100%; plan restrictions apply.

Referral is not a guarantee of program coverage.

Who can refer?

Anyone!

When will I hear back?

Please allow 48 business hours for a Pregnancy Navigator to contact you via email. If the request is urgent, please contact our office at 833-RVA-BABY between the hours of 10 am-2 pm M-Fri.

How can I schedule an intake appointment right away?

You will be taken to an appointment registration page after submitting your referral.

How can we help you?

Partners in Pregnancy Program - Home Visiting Richmond Resource Mothers - Teen Pregnancy Program Community Cares - Uninsured Social Support Program for Expectant families (Greater Richmond Region, Henrico and surrounding counties) ReByrth - Social Support/Doula Program for Women of Color (see website for waiver qualifications before submitting)

Insurance/Waiver Type

Optima Health Richmond Teen Waiver (expectant Central Virginia teens 14-19) ReByrth waiver (refer to website for qualifications) Uninsured

Client Date of Birth *

Date

Select which applies *

6-13 weeks pregnant 14-20 weeks pregnant 21-32 weeks pregnant 33-40+ weeks pregnant Postpartum

Estimated Due Date/Date of Delivery

Month Day Year

Member ID#

Referral Contact Name (Type N/A if not applicable)

Referral Contact Email

example@example.com

Referral Contact Phone

Area Code Phone Number

Client Information

Name *

First Name Last Name

What is your primary language

English Spanish French

Guardian's Name, If Minor

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Secondary Number/Guardian's Number (if minor)

Area Code Phone Number

E-mail Address *

Confirmation Email

Ethnicity *

Black or African American Hispanic or Latino White Asian American Indian Other

Additional Comments

Attach orders, face to face, health history, and demographics here

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