Please print, fill in, and bring these forms with you to your initial visit. If you have any questions about a particular form you may leave it blank and we will discuss it at your appointment. We look forward to seeing you!
Intro Letter (122 KB)
This letter explains my birth philosophy, scope of practice, and training. It also gives some detail as to what prenatal care with Brookhaven looks like in comparison to typical obstetrical care. We hope this letter answers some of your initial questions about out-of-hospital birth and midwifery care with Certified Professional Midwives.
No media download found. This Health History form gives the midwives some background information on your current and previous health status; helping us to determine whether or not you are a good candidate for out-of-hospital midwifery care.
regulatory disclosure (145 KB)
This packet contains information that Licensed Midwives are required by Virginia law
to give potential and current clients.
Midwifery Regulations (145 KB)
This is part of the above packet that Licensed Midwives are required to give to clients however, you do not have to print this document or bring it to your first visit unless you want to.
Records Request (123 KB)
If you have been receiving prenatal care elsewhere you will need to fill out this form and bring it to your first visit so that we can obtain a copy of your records and officially transfer your care to Brookhaven.
HIPPA (112 KB)
This is Brookhaven's HIPPA policy. You only need to print, sign, and return the last page.
MANA Stats (201 KB)
Brookhaven participates in the MANA Statistics Project. The purpose of the project is to document the value of midwifery care and to give midwives information we can use to maintain and improve the quality of our practice. You only need to return the second page of this form.