Looking for a midwife?

Please fill out our online intake form below, or call our office at 250-590-7605.

Thanks!

Your name (as it appears on BC Services Card)*
First Last
Your preferred name and pronouns
Partner(s)/main support person
First Last
Preferred pronouns of partner(s)/main support person
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Home Phone
Mobile Phone
Work Phone
Your Birth Date
When was the first day of your last menstrual cycle?
Approximately how many days long are your menstrual cycles?
Please enter a number from 15 to 40.
What is your expected due date?
Is this your first baby?
- Yes
- No
How are you feeling in your pregnancy so far?
How would you describe your health?
How did you hear about The Midwives Collective?
Are there any midwives you want to work with in particular?
Is there anything else you would like the midwives to know?
Comments
This field is for validation purposes and should be left unchanged.

Connect with us!

Our clinic is accessible, child-friendly, and community-focused. We are located in central Victoria, just past the intersection of Cook & Yates. We regularly host evening events and workshops, focusing on the journey from pregnancy into parenthood. (See our upcoming events in resources.) We have on-site parking and are well served by public transit. Our building offers a Lifelabs and a Rexall pharmacy and is fully wheelchair & stroller accessible. We look forward to hearing from you, and supporting you through pregnancy, birth, and the early postpartum.