Ask for a Midwife

To request midwifery care, you can call our office or fill out this form online.

By filling out this form you are asking for care from a midwife and agreeing to allow us to collect this information.  Within approximately 3 business days we will contact you to let you know if we are able to care for you.  If you have not heard back from us in 3 business days, please contact our office and we would be pleased to take your information over the phone.  Any information you provide will be stored in accordance with our privacy policy and the privacy standards for Ontario (privacy code). If your request is not able to be accommodated, we send the following information; name, birth date, postal code and expected date of birth; to the ministry to inform them of local demand; by submitting this form you are providing consent.

Please be aware that we cannot guarantee the security of your private information while it is in transit by email. If you have any concerns about sending personal information via email, please feel free to call our office (519-763-8568) and talk to us directly.