Midwives Forms

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These forms are available for download in Adobe Acrobat .pdf format. Acrobat Reader is necessary to view .pdf files. If you need to obtain a copy of this program it is available as a free download for Windows or Macintosh operating systems.

Please note the following policy regarding the filing of forms which collect a person's individual information:

"An individual who completes and files this form with the Texas Department of Licensing and Regulation (the Department) is entitled to the following from the Department:

(1) to be informed about the information that the Department collects about the individual, upon the request of the individual and subject to a few exceptions;

(2) to receive and review the information, under Sections 552.021 and 552.023 of the Texas Government Code; and

(3) to have the Department correct information about the individual that is incorrect, under Section 559.004 of the Texas Government Code."

Midwives Forms

MID001 Midwife Application (51KB PDF)

MID002 Newborn Screening Test Objection (20KB PDF)

MID003 Newborn Screening Agreement for Newborn Babies of Midwife Clients (20KB PDF)

MID004 Midwife Training Certification Form - Newborn Screening Specimen Collection (20KB PDF)

MID005 Texas Midwifery Basic Information and Instructor Manual (109KB PDF)

MID006 Midwife Notice of Change and Duplicate License Request (78KB PDF)

Midwives Informed Choice and Disclosure Statement (23KB PDF)

Other Forms

Disciplinary Action Questionnaire (98KB PDF)

Criminal History Questionnaire (63KB PDF)

Military Service Member, Military Veteran, or Military Spouse Supplemental Application (110KB PDF) - see Military Spouse Frequently Asked Questions

TDLR Complaint Sign (107KB PDF)

Request to Executive Director for Expired License Renewal (56KB PDF)

Criminal History Evaluation Letter