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Become a Client

If you are interested in midwifery care, please fill out this form and click on the submit button below. 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 may call our clinic at 519-928-2323. The information collected on the form is used to contact you and to guide discussion about your options for midwifery care. Your information will not be given to any third parties without your consent.

Submitting this form does not require you to commit to midwifery care, nor does it guarantee you a place with our practice. We will email or call you within approximately one week of your form submission to let you know if you will be offered midwifery care or be placed on our waitlist.

*required information

If you are placed on our waitlist, do you consent to our practice sharing your information with the Ministry and Guelph CHC? *