Documents (PDF Forms)

Below you will find the appropriate paperwork for your visit with our office. For every appointment, we ask that you bring with you your filled out paperwork, a current ID and your insurance card. (If you are transferring from another practice, especially if pregnant, please be sure to also have with you a copy of your records, if they are being faxed from another office, please be sure to check that we have received them prior to your appointment)

PREGNANCY VISIT
OB Questionaire Patient Demographics and Insurance Release of Records GYN Questionaire (for New Patients ONLY)
ANNUAL/GYN VISIT (bleeding problems, birth control, IUD check, UTI, STDs etc.)
GYN Questionaire Patient Demographics and Insurance Release of Records
St. John Medical Center Hospital Registration Process & Forms
Hospital Registation Sheet	A Healthy Pregnancy Booklet
Pregnancy Congratulations Letter	Family Birth Center Brochure
Car Seat Inspection Flyer	Family Birth Center Orientation Booklet
Hospital Admission Instruction For Labor	OB Checklist
The First Two Weeks - Infant Help Sheet	Childbirth Education Brochure 2015
Holistic Birth Center Brochure	Hospitalist Explanation Letter
OB/GYN Provider Sheet	WSPC Pediatric Referral Sheet
Pregnancy Resource Letter	What Every Pregnant Women Needs To Know
In your 8th month of pregnancy, we ask that you fill out your hospital pre-registration paperwork, and turn it into the office. We will then submitt with a copy of your current insurance to the hospital.
MISCELLANEOUS FORMS
Patient Registration
Release of Records From Westshore Midwifery	Release of Records To Westshore Midiwfery
Prenatal Plan of Care	Should I Call My Midwife?
Midwifery Philosophy	Birth Plan
Media Release	Self Induction Measures
CONSENTS
VBAC	Refusal of Routine Prenatal Testing
HBC	Water Labor
ACOG PRENATAL TESTING INFORMATION SHEETS
Transluciency 1st Check Screening	Cystic Fibrosis
Group Beta Strep Testing	Glucose Screening
HBC (Holistic Birth Center) Forms
HBC Consent	HBC Referral List
HBC Helpful Resources	HBC Survey
HBC Peds Agreement for Newborn Care	HBC Infant Care Consent

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“ Colleen is the best hospital midwife in the area! Highly recommend her and her staff, they are so professional and leave mom in control of her body and her birth. ”

Lisa W., Cleveland, Ohio

Documents (PDF Forms)

St. John Medical Center Hospital Registration Process & Forms

In your 8th month of pregnancy, we ask that you fill out your hospital pre-registration paperwork, and turn it into the office. We will then submitt with a copy of your current insurance to the hospital.

Section Options

Holistic Waterbirth

Waterbirth Facilities