New Client Forms

Please fill out the first three files and bring them to your first visit. We use Maternity Neighborhood electronic medical records. Once you receive your invitation to join via email, we ask that you fill out the registration and medical history forms on your chart. You will have the same access to your records as we do all the way through your pregnancy.

Payments can be made by check (payable to Kay Johnson or Debbie Pulley), cash, credit card*, or from HSA accounts. We are not Medicaid providers although outside services such as labs, consults and ultrasounds will be covered. If you have private insurance we will be happy to provide you with an itemized bill that you can use to apply for reimbursement from your insurance company after the baby is born.

A $25 charge per incident will be added for insufficient funds.

*3% handling fee will be added for any credit card transactions

 

Medicaid Information:

 

Insurance Sample Letters

We do not bill insurance for you, but many of our clients have had success being reimbursed by using these letters.