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Medicaid Doula Program Implementation Study: Medicaid Enrollee Participant Application

The following application is for Medicaid enrollees 18 and older who received doula care postpartum and who are interested in participating in the Medicaid Doula Program Implementation Study project through AcademyHealth and the University of Pittsburgh. Participation entails one 90-minute-long focus group interview. All research participants will be compensated for their time.

If the research team discovers that participants falsified their identify to meet eligibility criteria or attempted to submit multiple versions of this application, the team reserves the right to dismiss the participant from the study and not to pay them for participation.
1.First name:(Required.)
2.Last name:(Required.)
3.Email:(Required.)
4.Phone number:(Required.)
5.What is the best way to contact you? Note: If you do not have a preference, please select both boxes.(Required.)
6.Are you 18 years of age or older?(Required.)
7.Do you have a Hispanic or
Latino ethnic background?
8.What is your race? Please feel free to select all that apply.