Become A Client

Thank you for your interest in becoming a client. You can request midwifery care by either filling out this form, or by calling our clinic at 519-823-9785. We will contact you within approximately within one week to let you know if we are able to take you into care. If there is no space available, we will offer to place you on our waiting list.

We cannot guarantee that information sent electronically is kept private while it is in transit. If this is a concern for you, please call us instead. All information you send to us is stored in accordance to our privacy policy and the privacy standards for Ontario.

Please review our privacy policy before filling out the form.

Enter Information Below

(as it appears on your Health Card)

Pregnancy Information

(example 28 days or uncertain)

How many times have you given birth?
Please wait...
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