Quotation Estimate Midwife in United States San Francisco –Free Word Template Download with AI

Dear Ms. Whitfield,

Thank you for considering Golden Gate Maternal Care Associates for your prenatal, labor, and postpartum care needs. This Quotation Estimate outlines the comprehensive Midwife services we will provide to you throughout your pregnancy and delivery journey here in San Francisco, United States. Our licensed Midwife, Certified Nurse-Midwife (CNM) Dr. Sarah K. Okafor, will serve as your primary care provider from the first trimester through the postpartum period. This Quotation Estimate has been prepared in accordance with California Board of Registered Nursing regulations and the standards set forth by the American College of Nurse-Midwives for all Midwife services rendered within the United States.

1. This Quotation Estimate is valid for thirty (30) days from the date of issue. After July 12, 2025, pricing may be subject to revision based on current Midwife fee schedules in San Francisco, United States.
2. All Midwife services described herein are provided by a Certified Nurse-Midwife (CNM) licensed by the California Board of Registered Nursing. The Midwife operates in full compliance with California Health and Safety Code Section 1246 and all applicable federal regulations within the United States.
3. This Quotation Estimate is an estimate only and does not constitute a binding contract. Final charges may vary depending on the complexity of the pregnancy, any complications requiring additional Midwife interventions, or the need for transfer to a hospital obstetric team.
4. Payment is due within fifteen (15) days of each service invoice. A 1.5% monthly late fee will be applied to outstanding balances. A 20% deposit of the total estimated client responsibility is required to secure the Midwife's schedule for your expected delivery date.
5. Insurance billing will be handled by our office. The client is responsible for any deductibles, co-pays, or services not covered by their plan. This Quotation Estimate reflects standard Blue Shield of California reimbursement rates for Midwife services in the San Francisco metropolitan area.
6. In the event of a medical emergency requiring transfer from Midwife care to hospital-based obstetric care, all additional hospital charges, surgical fees, and specialist consultations will be billed separately and are not included in this Quotation Estimate.
7. All services will be rendered at our office located at 1200 Market Street, San Francisco, CA 94102, or at the client's residence within the city limits of San Francisco, United States, unless otherwise agreed upon in writing.
8. This Quotation Estimate does not include the cost of prescription medications, laboratory tests beyond those listed, or any ancillary services not explicitly itemized above.
9. By accepting this Quotation Estimate, the client acknowledges that they have had the opportunity to ask questions regarding the scope of Midwife services, the qualifications of the provider, and the applicable regulations governing Midwife practice in the State of California, United States.

By signing below, the client acknowledges receipt and acceptance of this Quotation Estimate for Midwife services to be provided in San Francisco, United States. The undersigned agrees to the terms and conditions outlined above.