Please read the following very carefully. Failure to properly follow these directions may result in your opinions NOT being commuicated to ATM and/or the midwife.
This evaluation form should only be used by clients of midwives who are current members of ATM. If you do not know if your midwife is a member of ATM, you should ask her or you may send an inquiry to our bookkeeper . (All midwives listed on this site are current members of ATM. However, all members are not listed on our site.) Please complete this form after your birth, being as open and honest as possible in evaluating the care given by the midwife during the prenatal, birth and postpartum periods.
Please read all the instructions below carefully and then fill in the blanks. Use the "send" button when you are finished and the form will be emailed to our bookkeeper. The completed form will then be placed in the midwife's file. All completed forms are kept strictly confidential. When several forms are collected for a particular midwife, they are then mailed to her so that she may evaluate her midwifery practice.
PDF Feedback Form
If you prefer a paper copy of this form which may be mailed to our office, click here for a PDF version which may be printed and used for mailing. The mailing address is included on the paper form.
Important Note: DO NOT use the address at the bottom of the PDF form when mailing the completed form in to ATM. Please mail to :
P.O. Box 887, Elmendorf, TX. 78112
DO NOT use this form if your intent is to file an official complaint against a midwife. This form is strictly a client feedback evaluation form which was designed by ATM to assist the midwife in improving her own midwifery services. This form is kept strictly confidential and is never used as information for an official complaint review.
If you believe a midwife has broken the law or if you think a midwife might be a risk to yourself or others please contact the Texas Midwifery Program hotline at 1-800-942-5540 to request the appropriate form for complaints or to obtain more information about filing a complaint.