Common Forms

I've placed common forms on this page that you may need during your experience with Moonbelly Midwifery.
To download a form, simply click on its link.

Initial Visit Forms
Please bring, or have these forms with you, for our first visit together.

• Pre-Consultation Questions
  


• Records Request to be sent to Moonbelly

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Maternity Forms

• Tips for a Healthy Pregnancy: WA Toxics Coalition
  
• Genetic Screening Options & Discussion
  

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Healthy Mama

• Plant based Iron-Rich Food Chart, by Kris Carr (Author of "Crazy Sexy")
  

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Informed Consent

• Informed Disclosure & Consent for Midwifery Care & Out of Hospital Birth
  

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Privacy Practices

• HIPAA Notice of Privacy Practices
  

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Records

• Records Release from Moonbelly
• Records Release to Moonbelly

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How to Order Baby's Birth Certificate:
By 36 - 38 weeks of pregnancy, please fill out the correct form to the best of your ability and bring it in to your midwife appointment.

• English version
  
• Spanish version
  
• Female Spouse/Domestic Partner version

I will file your child's Birth Certificate after I receive the completed Birth Filing Form (English version, Spanish version, Female Spouse/Domestic Partner version). Once I have entered it into the Department of Health system, they need 24 hours to process the birth certificate.

In Washington State, you will not automatically receive a copy of their Birth Certificate in the mail.  You need to order your birth certificate. To do this:

• You can go into your local Department of Public Health to order and receive a copy the same day.  
  
• You can also choose to click on THIS DEPARTMENT OF HEALTH LINK  to order (you will receive your copy in the mail)
  

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Midwifery Care Topics

• Midwives of WA State (MAWS): Indications for Discussion, Consultation & Transfer of Care
  

Healthy, whole mothers need a community of sisterhood, a tribe... who is in your tribe?

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