Postpartum Care Center
Mother and newborn intake, stay agreement and care plan, daily care log, newborn health tracker, and discharge follow-up for postpartum care centers
Get started with PocperMother and newborn intake, stay agreement and care plan, daily care log, newborn health tracker, and discharge follow-up for postpartum care centers
Get started with PocperThis agreement confirms the booking, pricing, included services, and house policies for your postpartum stay. Please review each section together with your family before signing.
Mother's name:
Baby's name:
Room type:
Check-in date:
Check-out date:
Total nights:
Room rate per night:
Package tier:
Standard
Premium
VIP
Total stay fee:
Deposit paid:
Balance due:
Payment schedule:
Meals per day:
3 main meals
5 — meals plus 2 snacks
6 — small meals throughout the day
Herbal tonic regimen:
Full traditional course
Modified — selected items only
None
Special dietary accommodations:
Lactation consultation:
Initial assessment
Follow-up sessions on request
Baby bath training session
Postpartum massage frequency:
Baby massage frequency:
Traditional confinement care:
Herbal bath / sponge bath service
Belly binding support
Mental wellness check-ins:
Daily wellbeing chat with caregiver
Weekly counsellor session on request
Doctor's weekly visit
Acupuncture sessions:
Photography package:
Sibling visit arrangement:
Additional lactation specialist hours:
Visiting hours, who may visit, sibling overnight rules, etc.:
I agree to limited visitor windows
I agree to health screening for all visitors
I agree to the no-photo policy in shared areas
Summary of the policy as agreed at booking:
I understand the 30-day cancellation rule
I understand the pro-rated early check-out terms
I understand the conditions under which the deposit is non-refundable
Refund terms agreed between center and family:
Mother's signature:
Partner / family signature:
Center representative:
Signing date:
I have read and agree to all terms in this stay agreement
Welcome — we are honoured to support your family during this special time. Please reach out to the front desk at any hour with questions.
The Stay Agreement & Care Plan template is a ready-to-use form from Pocper's Postpartum Care Center pack. Customize the fields to match your workflow, then share a link so clients can complete it and upload documents in real time.