If you are interested in midwifery care, please fill out this form and click on the submit button below. Please note that we use a secure internet connection to ensure the privacy of the information that you submit. However, if you do not feel comfortable providing this information online, you can choose to submit only your name and phone number so that we can contact you. Or, if you prefer, you may call our clinic at 519-928-2323.
Submitting this form does not require you to commit to midwifery care, nor does it guarantee you a place with our practice. We will review your form and call you within a few days. We are happy to answer any questions you may have over the phone, or arrange an in-person appointment at our clinic to help you determine if midwifery care is appropriate for you!
IF YOU HAVE NOT HEARD FROM US WITHIN 3 DAYS OF SUBMITTING YOUR FORM, PLEASE CALL OUR OFFICE!
The information collected on the form is used to contact you and to guide discussion about your options for midwifery care. If we are unable to accept you into midwifery care, we submit your postal code and date of birth to the Ministry of Health and Long-Term Care so that they can track unmet demand for midwifery services. Your information will not otherwise be given to any third parties without your consent.