Everyday Miracles and Aspirus St Lukes Request Form

Client Information - Parent / Guardian

Please enter Name exactly as it appears on the Insurance Card

If you would like to request a car seat for additional children, please email ruthe @everyday-miracles.org

We offer a few different pumps. Some are covered 100% by insurance and some models require an out-of-pocket upgrade charge. If you select a model that requires an upgrade charge, we will collect that payment below. Learn more about our pump options by clicking here.

We will need a prescription from your healthcare provider for a breast pump. You can email ruthe@everyday-miracles.org or fax (612-353-6437) this prescription to us.

If you have a preference on working with a Doula, please list up to 3 Doulas's in the comment section area. You can view our Doula's on our website.

Please note Doula matches are not guaranteed and as a small nonprofit, we do not have the capacity for clients to interview several doulas, then select one from that process. Your placement will be determined by your response to the Doula Confirmation Form, listed preferences, and doula availability around your estimated due date (EDD).

Everyday Miracles offers classes about childbirth, lactation, and newborn care. Most of these classes are fully covered by your insurance with no out-of-pocket cost to you. Are you interested in taking classes at Everyday Miracles? Are you interested in taking classes at Everyday Miracles? View our offerings by clicking here.