DONA International Grievance Form

An ethics claim is an objection lodged against a DONA certified doula or DONA member in which the doula is accused of behavior that violates DONA International’s Standards of Practice and/or Code of Ethics. It may be submitted by anyone, including but not limited to the client, their partner or family, a nurse, the client’s care provider, a hospital administrator, another doula, a DONA certified doula, a DONA approved doula trainer; or it may be originated by the Ethics Committee. If the objection is determined not to involve possible violations of the DONA International Standards of Practice and/or Code of Ethics by a DONA certified doula or DONA member, then it is not an ethics claim. It remains, by definition, a complaint. An incident is any potentially negative occurrence arising in a birth or postpartum support situation and involves the DONA certified doula or DONA member as the provider. The incident may be submitted to the Ethics Committee Chair by the doula or another party. Please provide as much detail as possible and you will be contacted by a DONA International Team Member.

Your Name(Required)

First Last

Your Phone(Required)

Your Email(Required)

Your Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Doula Name(Required)

First Last

Date of Incident(Required)

Doula Phone(Required)

Doula Email(Required)

Doula Website

This objection is believed to be:(Required)

Description of Incident(Required)

Provide a detailed description of the objection in the box below. Attach additional documents next. Reference the specific DONA International Standards of Practice or Code of Ethics alleged to have been violated, if known and understood.

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