Client Forms

New Midwifery Clients: Download, read, and complete all the forms listed below and bring them with you to your first visit. The midwives will answer any questions you have about the forms, and they can be signed at that time.

• Homebirth Handbook

• New Client Intake Form

• Emotional/ Social Needs Questionnaire

• Homebirth Agreement

• Financial Agreement

• Liability Disclosure

• HIV Testing Information

• MANA Statistics Project Info & Consent Form

• Notice & Acknowledgement of Privacy Practices

• Insurance Registration & Consent Form (please print this out and fill out, even if you have already verified your benefits through our biller)

• Email Communications Authorization

• Oregon Genetics Research Act

• Student Informed Consent

• Release of Medical Records (if you have already had any prenatal care or labs/ultrasound)

 New GYN Clients:  Download, read, and complete the forms listed below and bring them with you to your visit.

• Gynecology Intake Form

• Insurance Information Form (Please fill in top section)

• Notice & Acknowledgement of Privacy Practices

• Email Communications Authorization

• Oregon Genetics Research Act

• Student Informed Consent