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2025 Maternal Incentive - Doula Care Form UPDATE

A doula is a trained professional who provides emotional, physical and educational support to a mother who is pregnant, is in labor or has recently given birth.

Complete this form if you would like to request more information about doula services OR to claim your $50 gift card for the doula care incentive. It’s important to answer every question. 

To be eligible for the gift card, you must be a Priority Health Medicaid member. You must complete at least four visits with a doula before birth. Doula services are covered at no cost to you. Your gift card will be delivered via email.

 

Rewards are only offered for actions taken within the current year. Rewards cannot be applied retroactively for actions taken in previous years.

1. Are you a Priority Health Medicaid plan member? *This question is required.You must be a Priority Health Medicaid plan member to be eligible for this reward.

 
Doula Services
4. Are you submitting this form to request more information about doula services?
5. Are you submitting this form to claim your $50 gift card?
Have you completed at least 4 visits with your doula?
To be eligible for the gift card, you must complete at least four visits with a doula before birth.
I am interested in learning more about:
Personal Information
 
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid email address.
This question requires a valid date format of MM/DD/YYYY.
calendar
Resources
Want to learn more about our no-cost maternity programs and resources? Check all that apply. Our team will contact you.
11. Preferred Language
12. I am interested in learning more about:
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