Hiring Forms
by guisela figerora
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Midwifery ClientsPlease 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
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
Health History Form
Privacy and Protected Health Information