Midwife Self Pay Agreement for Clients without Insurance

Form Template

Birthing centers and midwives do not have the ability to give a “quote” before or at the time of the visit.

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This is because they can’t predict what services may be needed during an appointment. Each procedure code has a price attached to it and we would like our billing team to be able to discount those charges before giving you your final bill. The Midwife Self Pay Agreement for Clients without Insurance mobile app includes a self-payment agreement form for patients paying for their own medical services.

<a href="http://www.gocanvas.com/mobile-forms-apps/search?utf8=%E2%9C%93&terms=Midwife+PDR+Worksheet&categorysearchselect=

">GoCanvas has a collection of apps developed for Midwives and Doulas. They are all Free with your GoCanvas Subscription. Check them out in our Application Store!

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

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