Contact | East Ottawa Midwives - East Ottawa Midwives

Phone number *

Email *

Date of birth *

Do you currently have OHIP? *

Yes No

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

Preferred language for care: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

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

Yes No

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

What is your estimated due date? *

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? *

Are you currently in care with another midwifery practice in Ontario? *

Yes (see next question if you've selected this option) No

If you answered yes to the above question, please clarify which practice and how many visits you've had with them. *

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: *

Do you consent for us to send your name, date of birth, postal code and due date to the ministry of health? **This is so they can be aware of how many people are requesting care and that are not being accomodated due to waitlists that are too long. This will hopefully help us be able to get more funding for more midwives in the future.** *

Yes, I consent No, I do not consent

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: