Request For Midwifery Care

To request midwifery care for new or returning clients, please fill out this intake form. You may register at any time but we recommend that you contact us as early as possible.

By filling out this form you are asking for care from a midwife and agreeing to allow us to collect this information. This does not immediately guarantee a spot, but we will confirm with you within 1-2 business days. Any information you provide will be stored in accordance with our privacy policy and the privacy standards for Ontario. Please review our privacy policy before filling out the form.

If you have any questions prior to registering, or concerns about sending personal information, please call or text us at 226-332-0052, or email us at   We will be happy to discuss your questions or take your registration by phone.

Ask For A Midwife