New Client
Initiating Your Prenatal Chart
As your midwife, I am excited to support you during this precious time of life! I look forward to starting your care.
Health & Freedom Midwifery Care keeps a record of your care. Please complete these initial intake forms and bring them to your first appointment.
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Documents Required by Texas DSHS
As a midwifery client, the Texas Department of State Health Services wants to ensure you are given certain information during the course of your care. These documents and brochures can be found on this page. Please view or download the documents and read them prior to your first appointment.
Documents Required by Texas DSHS
Medical Records Request
We may need previous pregnancy records to complete your chart. Please use this form to request your medical records from the current pregnancy (if transferring care from another provider) or previous pregnancy if you have had a surgical birth.
Download Medical Record Request Form
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Insurance Coverage
Questions about health insurance coverage? You can contact your insurance provider to inquire about coverage. The billing service we work with can check your coverage and obtain pre-authorization for $25. Please contact us for further details.
Please complete the Insurance_Verification_Form before your free consultation if you would like us to contact your insurance company.