Quotation Estimate Midwife in United States Los Angeles –Free Word Template Download with AI

This Quotation Estimate is issued by Golden State Midwifery & Perinatal Care, LLC to provide a comprehensive, itemized cost breakdown for professional Midwife services to be rendered in the United States Los Angeles metropolitan area. This document serves as a formal, non-binding estimate of anticipated charges for the full scope of perinatal care, prenatal visits, labor and delivery support, and postpartum follow-up provided by a certified and licensed Midwife. All pricing reflects current 2025 fee schedules applicable to the United States Los Angeles region and is subject to the terms outlined herein.

The following Midwife services are included in this Quotation Estimate. Our Midwife, a Certified Nurse-Midwife (CNM) licensed by the California Board of Registered Nursing and certified by the American Midwifery Certification Board (AMCB), will provide evidence-based, patient-centered care throughout the entire perinatal period. Services are delivered at our clinic in Los Angeles, California, and at the client's private residence within the United States Los Angeles city limits, or at a partner birthing center as mutually agreed upon.

• This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, pricing may be adjusted to reflect changes in the United States Los Angeles healthcare market, insurance reimbursement rates, or regulatory fee updates.
• All Midwife services are provided in compliance with California Health and Safety Code, Title 22, and the California Midwifery Practice Act. Our Midwife operates under a collaborative practice agreement with a licensed obstetrician-gynecologist in Los Angeles, California.
• Home birth services are available within the city of Los Angeles and its immediate surrounding areas (including West Hollywood, Culver City, Santa Monica, and Beverly Hills). A home safety assessment will be conducted prior to scheduling delivery at the client's residence.
• Should a hospital transfer become medically necessary during labor or delivery, the Midwife will accompany the client to the nearest appropriate facility in the United States Los Angeles area. Transfer-related hospital charges are not included in this Quotation Estimate and will be billed separately by the receiving institution.
• Insurance billing: This Quotation Estimate reflects self-pay (out-of-pocket) rates. If the client elects to submit claims to a commercial insurance carrier or Medi-Cal, the final out-of-pocket amount may differ. Our billing office will coordinate directly with the insurer to determine covered benefits.
• A non-refundable deposit of $500.00 is required to secure the Midwife's availability for the estimated due date. The deposit is applied toward the final balance.
• Payment schedule: 25% at the time of signing the service agreement, 25% at 28 weeks gestation, 25% at 36 weeks gestation, and the remaining 25% within fourteen (14) days following delivery.
• This Quotation Estimate does not include costs for cesarean section, neonatal intensive care, or any surgical intervention. Such procedures fall outside the scope of Midwife practice and will be managed by the collaborating physician.
• All services are subject to the Midwife's clinical judgment. The Midwife reserves the right to modify the care plan if the client's health status changes, and any additional services rendered will be communicated and documented prior to provision.

By signing below, the client acknowledges receipt of this Quotation Estimate for Midwife services in the United States Los Angeles area and agrees to the terms, conditions, and estimated pricing outlined in this document. This signature does not constitute a binding contract until a separate Service Agreement is executed by both parties.