Urban Baby Beginnings Community Cares

Referral Partner *

Insurance/Waiver Type *

Optima Health Medicaid Central Virginia Teen (14-19) St. Francis Family Medicine Richmond ReByrth Community Doula Referral (Now accepting referrals for 1/15/2022 or later - Norfolk and Richmond residents identifying as BIPOC only)

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.

If you are Medicaid/WIC eligible and are pregnant or have given birth within the last six months; and live in City of Richmond or Norfolk, VA...

You are eligible for community doula care to provide you physical, emotional, and informational support before, during and after you give birth. Please attempt to get a licensed practitioner's recommendation for UBB to provide care under this program. You can request a recommendation (for example, from a doctor/midwife/nurse¹) and have it sent to us or your provider can fill out the requested form.

If you are a licensed practitioner²...

By filling out this recommendation form, you are enabling this individual to access non-clinical community doula services². A recommendation is not the same as a prescription/medical order.

Licensed Practitioner's Recommendation for Doula Care

VA Member Full Legal Name (first, last) *

First Name Last Name

VA Member DOB (MM DD YYYY): *

Date

VA Member Phone Number *

Area Code Phone Number

VA Member Email

Confirmation Email

Address *

Street Address

Street Address Line 2

City State

Zip Code

Managed Care Organization (Medicaid) Member ID#

Estimated Due Date/Date of Delivery

Month Day Year

Select which applies *

6-12 weeks pregnant 13-26 weeks pregnant 27-40+ weeks pregnant Postpartum

Member's primary language

English Spanish French

Licensed Practitioner's Signature: *

Clear

Licensed Practitioner's Full Legal Name (first, middle, last): *

Licensed Practitioner's NPI# (Doula Care Recommendation Only) *

Date of Recommendation (MM DD YYYY):

Date

Name of Doula (optional):

A Licensed Provider; for the sake of the proposed doula benefit, is classified as a: physician, licensed mental health professional, licensed clinical psychologist, licensed professional counselor, nurse practitioner, certified nurse midwife, licensed midwife, physician assistant, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, or certified psychiatric clinical nurse specialist