BFHI Accreditation (Individual)

BFHI Accreditation
BFHI Coordinator Details
Full Name *
Organisation Name *
Position*
Phone Number*
Email*
example@example.com
Facility Details
Facility Name*
Local health network (if applicable)
Maternity unit manager*
Facility Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Suggested date for assessment*

DayMonthYear
Please note: If this is your first accreditation, we recommend selecting a date in 6 months time. All dates are subject to availability and we will be in touch to confirm your accreditation.

Please choose your band

$5,010 (Band 1)$6,880 (Band 2)$9,380 (Band 3)$11,250 (Band 4)$11,950 (Band 5)
Maternity Facility Financial Agreement

Once we receive your application ACM will raise an invoice. Please provide the billing details:
Invoice to:*
Facility name
Contact Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Purchase order # (if applicable)
I, {fullName26}, {position}, on behalf of {facilityName}, {facilityAddress} agree to pay a total of {pleaseChoose41} (cost of entire assessment) prior to the assessment date.
I understand that if my facility does not meet the minimum standards for accreditation, partial re-assessment may be required, and we will incur an additional charge.I understand no refund will be given for cancellation and that an additional admin fee may apply if accreditation is postponed within 45 days of the agreed date.
Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty:

BFHI Accreditation