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Doula Client Confidentiality Release Form Mobile App

Due to the HIPAA regulations all doulas should have a signed release form from their client before taking any notes about them or their labor. The best way to be fully compliant would be to get this release signature at the first prenatal visit, or upon first meeting and joining the client for her labor and delivery. Certification candidates should have this form signed before taking any notes. Clients should receive a copy of the form they signed, and the doula should have her copy with her at the labor and birth to be able to show that she is indeed complying with the HIPAA regulations if questioned. Confidentiality of medical and personal information obtained during the course of the doula’s work is of the utmost importance. Failure to comply with these confidentiality regulations could result in penalties.

GoCanvas has a collection of apps developed for Midwives and Doulas. They are all Free with your GoCanvas Subscription. Check them out in our Application Store!

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

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Take a peek inside the Doula Client Confidentiality Release Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Due to the HIPAA regulations all doulas should have a signed release form from their client befor...

  • Ico textbox


  • Ico multiline

    at (address),

  • Ico textbox


  • Ico textbox

    give my permission, for my doula,

  • Ico statictext

    to take notes about me, including personal information I choose to disclose to her, and informati...

  • Ico signature


  • Ico date


  • ...and More!

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