Caregiver Reference Form

Thank you for providing a reference for a caregiver applying to join the Fourth Support Colorado team as a postpartum doula or newborn care specialist. Your honest feedback helps us ensure we match families with exceptional support providers. This form should take about 3–5 minutes to complete.

Your Name

Caregiver's Name

How long have you known/worked with this caregiver?

less than 6 months

6-12 months

1-3 years

3+ years

Please rate this caregiver on the following:

Punctuality and reliability

Excellent

Good

Fair

Needs Improvement

Professionalism

Excellent

Good

Fair

Needs Improvement

Communication with families

Excellent

Good

Fair

Needs Improvement

Confidence in caring for newborns

Excellent

Good

Fair

Needs Improvement

Ability to support new parents emotionally

Excellent

Good

Fair

Needs Improvement

Organization and attention to detail

Excellent

Good

Fair

Needs Improvement

In a few sentences, how would you describe your experience working with this caregiver? (You might mention their strengths, personality, how they supported families, or why you would or would not recommend them.)

What stood out most about working with this caregiver? (You might mention something like their calming presence, newborn knowledge, emotional support for parents, reliability, or anything that made them exceptional.)

Is there anything else you think we should know about this caregiver?

Would you recommend this caregiver for work with postpartum families and newborns?

Yes

Maybe

No

Would you hire/work with them again?

Yes

No

N/A

I give permission for Fourth Support Colorado to use a portion of my written recommendation in this caregiver’s professional portfolio or marketing materials.

Yes - first name only

Yes - initials only

Yes - anonymously

Not at this time

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caregiver reference form