AND
FINAL CHAPTER DOULA SERVICES, LLC (“Final Chapter”)
BY: Allison Blakley, End-of-Life Doula
2940 Moon Hill Drive, Northbrook, IL 60062
847-571-3201
allison@finalchapterdoula.com
RECITALS
WHEREAS, the Client has sought and Final Chapter has agreed to provide end-of-life doula services, including but not limited to death planning, and emotional, physical, and spiritual support, guidance, and comfort for the Client and/or Client's loved ones during Client’s end-of-life journey;
WHEREAS, Client or Client’s Financial Guarantor (hereafter collectively “Client”) has agreed to pay for doula services provided by Final Chapter in accordance with Final Chapter’s currently posted fee schedule; and further provided that the pricing for any legacy project will be agreed upon between the parties hereto before said project is commenced; and that all services billed on an hourly basis will be billed in quarter-hour increments;
NOW, THEREFORE, in consideration of the mutual promises, covenants, and conditions contained herein, the parties agree as follows:
1. Scope of Services
Final Chapter agrees to provide the following services, as requested by the Client:
- Death Planning: Developing an overall plan for the service period which includes the location where client prefers services be provided; what other professionals (hospice workers, home health aides, CNAs, paid companions) will be providing services to client during the final weeks of client’s life and the expected division of labor among such professionals; and the degree and nature of medical intervention client plans to pursue during the final weeks of client’s life.
- Emotional and Psychological Support: Offering compassionate companionship, active listening, and non-judgmental presence.
- Spiritual Support: Providing spiritual guidance, rituals, or practices that may be comforting, in alignment with the Client’s beliefs.
- Vigil Planning and Support: Planning for the kinds of interactions Client will have with visitors during the final weeks of client’s life, including identifying those persons, if any, with whom Client wishes to have no contact; planning and coordinating a schedule for who may visit during what hours; following Client’s wishes as to periods of time, if any, when Client wishes to limit visitors; and developing visitor rituals.
- Legacy and Remembrance: Assisting the Client with legacy work, life review, memory-making, and facilitating the creation of meaningful rituals or practices.
- Family Support: Supporting family members in navigating their own emotions and preparing for the end-of-life transition.
- Respite Care: Offering family caregivers respite, ensuring they have time to rest while Final Chapter provides companionship and support.
- Other services:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
2. Term of Agreement
This Agreement shall commence on the date of execution and remain in effect until 48 hours after the Client’s end-of-life transition or until terminated by either party, upon 48-hours written notice.
3. Fees and Payment Terms
Retainer: A retainer of $______ is required upon signing this Agreement to secure Final Chapter’s availability. This amount will be credited toward the total service fee.
Payment Schedule: Services will be billed weekly and paid within seven days of billing by PayPal, Venmo, cash, or check.
Cancellation Policy: If the Client cancels a scheduled visit within 18 hours of the appointment, a cancellation fee of $150 will apply. If services are terminated prematurely by the Client before the retainer has been fully used, a refund may be issued for unused services at the Doula’s discretion.
Additional Costs: Any out-of-pocket expenses incurred by Final Chapter on behalf of the Client, e.g., additional travel beyond Final Chapter to point-of-service will be billed separately at $0.75/mile, along with any special materials costs.
4. Confidentiality
Final Chapter agrees to maintain the confidentiality of all information shared by the Client or Client's family, except as required by law or in situations where there is a risk of harm. All information related to the Client's care, including personal, medical, and family details, shall remain strictly confidential.
5. Client Responsibilities
The Client agrees to:
Provide accurate and timely information regarding health status, preferences, and any changes in the end-of-life care plan.
Ensure access to appropriate medical and health records for Final Chapter to provide effective support, including the execution of any necessary Authorizations to Release Records.
Maintain open communication regarding the Client’s emotional, physical, and spiritual needs.
6. Limitation of Liability
Final Chapter’s services are non-legal and non-medical in nature and do not replace the care or advice of licensed professionals. Final Chapter is not responsible for any legal or medical decisions or procedures, nor is Final Chapter licensed to provide legal, medical, or nursing care.
While Final Chapter will make reasonable efforts to provide emotional and comfort care, Final Chapter is not liable for any outcomes related to the Client’s medical or health status, nor for any damages arising from services provided. Final Chapter is not being retained to provide any physical care to Client and Final Chapter is not responsible for any injury to any other person or property arising out of Final Chapter providing incidental assistance to other professionals or family members when requested.
7. Termination of Services
Either party may terminate this Agreement at any time by providing 48 hours written notice to the other party. If services are terminated by the Client before the completion of the agreed-upon service duration, the Client agrees to pay for services rendered up to the date of termination within three days of the Agreement’s termination.
8. Indemnification
The Client agrees to indemnify, defend, and hold harmless Final Chapter of and from any and all claims, damages, liabilities, and expenses arising out of or related to the services provided under this Agreement, except for acts of gross negligence or willful misconduct by Final Chapter.
9. Dispute Resolution
In the event of a dispute arising from this Agreement, the parties agree to engage in mediation to resolve the matter. If mediation is unsuccessful, the dispute may be taken to binding arbitration, in accordance with the rules of the American Arbitration Association.
10. Miscellaneous
