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Baby Nurse Directory Client Application

Please fill out the form completely. After we receive your information we will send the information you send us to the available Newborn Care Specialist's. They will respond with their interest. We will then email you the names, resume, bio and phone numbers of each of the respondents. There should be a minimum of 3 unless this is a last minute request or unless you are in an area we have limited coverage. Please begin this procedure ASAP. You will have a larger selection of available specialists. We recommend you begin with a phone interview. The Baby Nurse Directory is not responsible for the quality of the Baby Nurse or Newborn Care Specialist you hire. We are only a directory not an agency. If you wish to hire an agency that will do all the background and reference checking and find the Newborn Care Specialist for you please go to Exclusively Baby Nurses.
Name:
Email Address:
Phone Number:  
City
State and Zip Code
Address
Cross Streets
How did you hear about us?
When would you like help (Month/Day)?
How long would you require a Newborn Care Specialist? Days, Months, Weeks
I am looking for:  Night Duty
 Day Duty
 Round the Clock Duty
 Sleep Training
 Doula Services
 RN Services
 Consultation
If you require an RN, please explain why.
If you are requesting round the clock service, we may be able to fill your request quicker by doing a nationwide search. You would be responsible for travel arrangements. Please indicate if you would consider a nationwide search.
If you are requesting a consult, please explain what your issue is.
How will you be feeding your baby? Breast Feeding Exclusively
 Bottle Feeding
 Breast and Bottle
 Pumping and Bottle
 Day - Breast, Night - Bottle
I am expecting Single Baby
 Twins
 Triplets
 Quads
If your baby has already been born.. Was your baby premature? If so, how many weeks?
If your baby has already been born - is your baby on medication? Yes, for reflux
 Yes, for colic
 Yes, other
If your baby has already been born - what is the current weight, age and sex.
Do you need help with nursery set up? Yes
 No
 Please send a nursery suggestions list
Do you have an animals - if so what?
Do you have any other children keeping in mind the NCS cares only for the newborn?
Is this a smoking enviroment? Yes
 No
If this is a night position where will the Newborn Care Specialist rest? Baby's Room
 Guest Room
 Couch
 Casita
Is this a night awake job (The Newborn Care Specialist is not allowed to sleep on the job)? If so your hourly charge will be more. Yes
 No

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The Baby Nurse Directory 2006
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