Important Forms for Midwives

Applications may be emailed to [email protected] or faxed to (425) 536-8221.

Frequently Used Forms

Use this form to apply for JUA coverage if you are a Licensed Midwife or Certified Nurse-Midwife in Washington State.

Use this form to apply for JUA coverage if you are the owner of a Licensed Freestanding Birth Center in Washington State.

Use this form for a non-JUA-insured midwife acting as locum for a JUA-insured midwife.

Do not email incident reports. Either fax them or upload to this secure portal.

Use this form when you are canceling your policy and need to report the number of primary births that you performed this year .

Payment Authorization Forms

Payment authorization forms may be uploaded to the secure portal. For your own protection, please do not email your bank or credit card information unless you have encrypted email.

For automatic bank transfers (monthly payments only)

Transaction fees: 1.5% for debit, 2.4% for credit


Relevant Links for Midwives & Birth Centers

Need to renew your license? Can’t find the legend drugs & devices? Not sure where else you should report an incident? We’ve got you covered.

Licensing & Regulatory Agencies

Laws, Rules & Scope of Practice

Required Reporting of Incidents

Quality Improvement & Hospital Collaboration