Mountain Midwifery Forms:
We've placed common forms on this page you may need/encounter during your experience at MMC. To download a form simply click on its link. If you need a form completed by us or any other business request (i.e. FMLA paperwork, disability paperwork, FLEX receipt, copy of entire medical chart, letter to return to work, etc.), please give us sufficient time to complete it before it's due; we may take 5-10 business days to these tasks.
Your clinic visits occur in Suite 300, upstairs from The Midwife's Garden (the education space, aka Blossom Wellness). Suite 300 is just inside the gate from the half-circle turnaround on Clarkson Street.
- Financial Policy
- Initial Visit Questions
- Patient Information Form
- Records Request to MMC
- Records Release from MMC
Please note the following:
- The Initial Visit is a medical visit and is not appropriate for detailed questions regarding insurance, billing, and the birth center model of care. Please ask those questions at an Orientation or outside your appointment with our reception desk, or by email to firstname.lastname@example.org
- We require $160.00 of all patients at the initial pregnancy / maternity visit. If insurance does pay for your visit, these monies may be used to cover administrative fees, maternity copays, facility fees, or classes.
- For non-medical phone call-backs, we return calls within 1 business day, so call-backs for new OB appts or billing questions or class sign-ups may not occur until the day after a message is left.
- Within 2 weeks of your initial visit we will have an estimate of what you'll owe for maternity care and facility fees.
- Tricare? for ALL Tricare plans, we must pre-authorize your care before we can see you. Please provide your DoD ID/Benefits # and Sponsor SSN when making your appointment.
Lobbying and Industry Relations
- Dietary Recall
- Newborn Health Record Checklist
- Birth Certificate worksheet
- Questionnaire Client_Maternity Eval
- GTT Testing Information
- Swedish Pre Admiit (Form)
- Swedish PreAdmit (website)
- Consent_Vitamin K_Eye TX
- HIV Pregnancy Consent