Naturopathic Midwives of Bellingham

New Patient Intake Form

Prior to your appointment, please fill out the the adult intake and privacy practices form and bring them with you to your first appointment. If you are coming in for a midwifery consult or a midwifery first office call, please print out the Midwifery Registration form in addition to these other two forms.

For a child under the age of 14, please fill out the pediatric intake and the notice of privacy practices.

If you would like to request records from a previous provider and have them sent directly to us, you can fill out the records release form and fax or mail it to your previous provider. If you are unclear about what records to request, we can help you fill this out at your first office visit.

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