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.

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?

Cost is dependent on the services provided.

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

Our City of Richmond Resource Mothers Teen program, Community Cares Uninsured program, Family Spirit Partners in Pregnancy Home Visiting program (insurance dependent) and Project ReByrth program for expectant Henrico residents is FREE upon registration and approval.

Outside of these programs, payment plans are available for those who need it and do not qualify.

Super Bill provided for HSA reimbursement.

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 ReByrth - Social Support/Doula Program for Women of Color

Insurance-Health Care Organization - Program Waiver *

Optima Health Richmond Teen Waiver (expectant City of Richmond teens 14-19) ReByrth waiver (inquire for qualifications) Uninsured Self-Pay

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

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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