If you are registering for care at Mother's Own Birth Center, the following forms can be downloaded as pdf's. The Informed Consent, Rights and Responsibilities, and Financial Agreement are for your information only. The registration form and any other forms requiring signatures should be brought to your first prenatal visit.

Registration Form

Informed Consent for Birth Center Care 

Rights and Responsibilities

Signature Page for Consent Forms

Below is the financial agreement and payment form. These forms are new for 2011 and apply to all clients beginning care on or after January 1, 2011. Please complete the Client Registration Form and fax to Christine at Larsen Billing. The $25 fee is actually $15 and needs to be paid before Larsen Billing will check benefits with your private/commercial insurance.  This fee does not apply if you have Ohio or Michigan Medicaid, but the form still needs to be sent in (mail or fax). Please bring copies of the Payment Agreement to your first visit.

Client Registration Form for Larsen Billing

Financial Agreement for Mother's Own Birth Center. Please also download the Financial Agreement Signature Page.

Payment Agreement arranged with Larsen Billing for Mother's Own

Larsen Billing has also provided the following pdf to help you understand how their billing for services and payment from your insurance work. Understanding Your Insurance Claims

MANA Statistics Project

We belong to the Midwives Alliance, a big North American organization of midwives. The organization collects data on midwife-attended births so that research can be done on how midwives take care of moms. The more data we collect, the better the research will be. The research can be used to improve the way we practice and to show how midwifery care is different from care by doctors. We ask all our clients to allow us to collect data on how we take care of you, both to contribute to research and to help our practice look at its own statistics--our c-section rate, et cetera--and improve our own ways we provide care.  The consent form is below

MANA Statistics Project Consent Form

The following forms relate to your care and the baby's care after birth. Please read the related information pages before signing the informed consent/ informed refusal form.

Signature Page for Consent/Decline Prenatal Testing

Understanding Blood Sugar During Pregnancy 

Before your first visit please read this page  from Pam Vireday's Plus Size Pregnancy web site to understand your risk factors  for diabetes during pregnancy/gestational diabetes and whether you should be tested for gestational diabetes during this pregnancy.

Understanding the Need for Vitamin D Supplementation

Newborn Tests amd Procedures Consent/Refusal

These forms are .pdf and are offered here for your convenience. You may also obtain paper copies from our office. Hope this is helpful to you.

 

Circumcision

I am adding this link here because I thought it might be easier to find  here rather than on the links page:

Circumcision Decision Maker

The interactive tool provides a lot of information that will help in making the decision to circumcise or not. It includes a section entitled, "Are you arguing about circumcision?"

 

Food Safety

The first link is the FDA seafood safety brochure

What You Need to Know About Mercury in Fish and Shellfish

The second is the FDA food safety site. Helpful information is found toward the bottom in the left hand column.

Food Safety for Pregnant Women