Forms & Payments | Inside Passage Midwifery

Forms to have Filled Out:

Adult Intake Form [pdf] -
General Information & Registration, Client Background Medical Information & Family History, Insurance & Financial Information, and Context of Care Review Forms
Midwifery Form [pdf] -
General Information & Registration, Insurance & Financial Information, Client Background Medical Information & Family History, Previous Birth History
Pediatric Form [pdf] -
General Information & Registration, Insurance & Financial Information, Pediatric Health & Family History, Developmental and Social History

Pay Your Bill Online:

You can make a payment or pay your whole bill online. The payment form will appear as a donation, but be sure to include your billing invoice number at the final step and I will apply your payment to your bill. I will also email you back when I receive your payment. Thank you.