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Midwife Maternity Financial Policy Mobile App

Midwives and Doulas can use the Midwife Maternity Financial Policy mobile app to inform patients of their financial policy and financial obligations for midwife services. The app covers payment plans, Incidental labs, procedures and medications, newborn care, education, registration fee, referred services and transfers. This app can easily be customized to match your current midwife company’s financial policy. The app captures the patient’s signature.

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Customize to add, remove, or edit any of the fields below.

Payment Plan: After your initial visit, we estimate your financial responsibility for a birth cen...
FSA: It is NOT recommended for clients to use FSA funds for upfront payments.
Incidental Labs, Procedures and Medications: All incidental labs, procedures and medications that...
Verification of pregnancy visit Labs and specimen draws
Medications for labor/birth Birth preparation, breastfeeding & postpartum classes
Fetal non-stress tests Ultrasounds
Hydration/IV fluids Herbal remedies
Cervical balloon Newborn care at birth and follow up visits
Use of Nitrous Oxide at birth Visits to address non-routine problems & acute illness
Newborn care: <Insert Name> midwives provide newborn-specific care at birth and may provide more...
Education: Education is an important part of birth center care but these services are often not c...
Registration Fee: This will reserve your spot in your due date month, pay for maternity education...
Referred Services: Some services like complicated ultrasounds, doula support and circumcision are...
Transfers: in the event of a hospital transfer, clients receive care from providers and facilitie...
Client Name
Signature
Date
...and More!

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