Contact | East Ottawa Midwives - East Ottawa Midwives

Phone number *

Email *

Date of birth *

Do you currently have OHIP? *

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Do you have a preference of midwife? If yes, please indicate the name below: *

Preferred language for care: *

Address *

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Do you plan to move outside the Ottawa area during your pregnancy or the first 6 weeks postpartum? *

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What is the FIRST day of your last menstrual cycle? *

What is your estimated due date? *

How many total pregnancies have you had (including miscarriages and the current one)? *

Are you currently taking any medication? If yes, please specify what for. *

Have you previously given birth? If yes, how many times? *

If you have given birth, what type of birth was it? *

If you had a cesarean: in what year? Are you hoping for a repeat cesarean or attempting a vaginal birth? *

If you have given birth, how many weeks gestation were you? *

Do you have any medical conditions or health concerns? If yes, please specify below. *

Planned place of birth (please enter your preferred location) *

Have you previously been a client at East Ottawa Midwives? If yes, who was your midwife/midwives? *

Any other significant details about your previous pregnancy/birth history? Any complications (pre-eclampsia, gestational diabetes, etc.)? *

Other identity or circumstances that you are comfortable sharing that are important for us to consider (including surrogate, twins, issues of poverty, violence, etc.), please specify: *

We thank you for sharing this with us. We would love to accommodate everyone however due to limited resources, we cannot guarantee a spot in our care. You will be contacted by our staff if there is a spot for you.

Our Location

Please fill out the form below to apply for care: