Minnesota Midwife Census
To get an accurate count, location and practice type of all the community midwives practicing in Minnesota
Email *
Full name *
Practice Name *
Practice office location *
Contact information phone address email etc. Please note best/preferred method of contact *
Route of Entry to Midwifery (credentials) *
How long have you been practicing *
Who did you train with? Schooling/training and preceptor(s) *
What area do you serve, how far do you travel? *
Are the majority of your births rural, suburban, urban? *
Do you work with apprenticing midwives? *
Do you primarily serve a particular population? *
How can the midwife organization help you in your practice? ie: medical outreach, supplies, classes, et cetera *
At this point the intent is to keep this census information within the MMG organization. However, in the future would you prefer that your business contact information *
Date you completed this census *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy