Breath of Life Midwifery

Take Back Your Birth!

New Clients Required Forms

To Be Completed Upon Initiation of Care by All Clients

Client Records Release:
Client Intake and Medical History:
Informed Disclosure Agreement:
Practice Guidelines:
Emergency Care Plan

VA Required Disclosures (Only complete those that apply to you.)
Financial Agreements

Financial Agreement - Self Pay:
Financial Agreement - Medicaid:
Medicaid MCO Exemption Form:

Between 24 and 30 Weeks

Gestational Diabetes Screening:

At 36 Weeks