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Hiring Forms

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by guisela figerora

Midwifery Clients

Please complete the following forms and bring them with you to your first visit
          Hiring Agreement
          Informed Choice Disclosure
          Financial Agreement
          Emergency Transport Plan
          Privacy and Protected Health Information 
          MANA Statistics Project
          High Risk Pregnancy Disclosures
Please read the following  
          Virginia Regulations for Licensed Midwives
then print and  sign this statement 
          Virginia Licensed Midwife Regulatory Disclosure

    Doula Clients

      Please complete the following forms and bring them with you to our first visit.
             Birth Doula Hiring Form
​
             Postpartum Doula Hiring Form
             Privacy and Protected Health Information

    Maya Abdominal Therapy Clients

     Please complete the following forms and bring them with you to your visit.
            Health History Form
            Privacy and Protected Health Information

    Other Information

      Birth Supply List
      Diet Diary

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