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. 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 concerns about sending personal information via email, please feel free to call our office (519-823-9785) and register directly.

Ask For A Midwife