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Monday, July 15, 2024
call now 602-midwife (602-643-9433)

Click on a form or a link below to view a PDF version of our current client forms.


Informed Disclosure and Consent for Midwifery Care

This form is required for all new clients.

pdfInformed Disclosure and Consent127.02 KB


Midwifery Emergency Care Plan

This form must be completed by all new clients.

pdfMidwifery Emergency Care Plan161.53 KB



AZ Dept of Health - Informed Consent

The state requires that all midwifery clients sign this form to confirm that you have received all required information and resources.

pdfAZ Informed Consent139.64 KB


AZ Dept of Health - Assertation to Decline On-Going Required Tests

The State of Arizona requires this form if you are going to decline any of their required pregnancy tests routinely done during prenatal visits.

pdfAZ Decline Ongoing Tests138.54 KB


AZ Dept of Health - Assertation to Decline Tests Required within 28 Weeks

This form is required to decline specific tests that the state requires of all mothers by the 28th week of pregnancy.

pdfAZ Decline Tests 28 Weeks84.45 KB


Home Birth Supply List - Please Purchase These Items to Prepare for Home Birth

We have prepared a birth kit of specialized items that may not be commonly purchased at a local grocery or department store.  You can purchase our birth kit at this link:

Two items need probably to be purchased online at these links:

The third part of this is a list of items commonly available at local retailers (or online).  Print the form below out with you and take to local stores.

pdfazm-new-BirthSupplyList-2014c.pdf124.12 KB


Records Release Form - To Request Records from Another Healthcare provider

Complete this form if you have been treated by another health care professional during this or previous pregnancies.

pdfazmidwife_RecordsRelease-2014a.pdf121.55 KB


Midwifery Consult and Transfer of Care Standards

This form identifies situations where a medical consultation or transfer of care is required under Arizona rules and statutes.

pdfazmidwife_ConsultTransferStandards-2014a.pdf191.42 KB


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What Moms Say About Alicia

From our client testimonials and stories pages.

"She gave me the courage to do things I wasn't sure about and the knowledge about things I had no idea about!"
  -- Kursta Robinson

"She really upheld the sacred space of my bedroom when I was laboring and encouraged me after birth to BE with my newborn."
  -- Katie Mullins

"She gave us peace of mind and reassurance as we navigated our first birth."
  -- Melissa Kohler

"You become part of her family when you receive care from her."
  -- Sara Walters

"She has exceeded my expectations, which is not an easy thing to do."
  -- Naomi Thomas

"I have online access to everything, my notes, stats, ultrasound reports, whenever I want which makes me feel in control and informed."
  -- Tikla Fife

"She also helped keep me focused, and kept encouraging me every step of the way."
  -- Evelyn Hernandez

"If you are looking for a kind, genuine, knowledgeable individual that will respect your birthing preferences for what they are, Alicia is a perfect fit for you."
  -- Marie Repec

"She never rushed us through appointments - we always felt like she was there to answer all of our questions."
  -- Danielle Hazeltine

"She is knowledgeable and always had the answers that I needed in time of concern/panic."
  -- Heather Groom

"Her gentle presence was part of what made our birth excellent!"
  -- Melissa Kohler

"I want you to know from my heart that I think you are truly wonderful at what you do.  My birth would not have been the same without you there."
  -- Sara Ann Tyler