Clinical Hours Verification Form | Neonatal Touch and Massage Certification

Please complete this form to validate the Neonatal Touch & Massage Certification Applicant has completed a minimum of 1000 hours of direct neonatal patient care in the NICU/SCN. You can also copy and send this link https://www.neonatalcertification.com/clinical-hours-verification/ to your supervisor or co-worker for them to complete the form.
If you have any questions, please contact us at 1-855-CTC-NTMC or info@infantdriven.com
Name of Neonatal Touch & Massage Certification Applicant*
First Last
Profession
Verification*
- I confirm to the best of my knowledge that the above named individual has completed a minimum of 1000 hours of neonatal caregiving in the Neonatal Intensive Care Unit or Special Care Unit.
Name*
First Last
Profession*
Relationship*
Email Address*
CAPTCHA