Looking for a midwife in Toronto?

Find a Toronto midwife at our clinic with our form below. Our clinic is located in the East York/Don Mills area of Toronto. Our midwives have privileges at Michael Garron Hospital (Toronto East General Hospital) in East York and Scarborough area (near the Beaches), as well the Toronto Birth Centre near Riverdale, Regent Park, Cabbagetown and downtown Toronto. Midwifery clinics can also choose to have a home birth.

First Name (required - as it appears on your health card)

Last Name (required - as it appears on your health card)

Preferred first name (if different)

What's your preferred gender pronoun? (e.g. her, him, they)

Name of your partner/support person (first, last name)

What's your partner's preferred gender pronoun? (e.g. her, him, they)

Your Email

City where you live: (required)

Major street intersection near your home (required)

Postal code (required)

Language(s) spoken at home

Please enter the best phone number to reach you at (required)

Is it okay to leave messages? (required)
YesNo

Please enter your work phone number (leave blank if you do not want us to call this number)

Is it okay to leave messages?
YesNo

Alternate phone number

Is it okay to leave messages at this number?
YesNo

Is this number your:
cellhomepartner's numberother

Your date of birth (required)
Month
Day
Year

When was the first day of your last menstrual period? Please note that we are unable to process your form without a sense of when you are due.
Month
Day
Year

Not sure about when your last menstrual period was

If you know your estimated due date, enter it here. (required) - Need help calculating your due date? - (not available on mobile browsers)
Month
Day

Unable to estimate your due date to the nearest month

Is this based on:

Where do you plan to have your baby? (required)

Do you have plans for pain medication during your birth?

How many vaginal births have you had? (required)

How many C-section births have you had? (required)

Do you have any medical conditions like diabetes, epilepsy or thyroid issues? (required)
YesNo
If yes, please provide more information about their duration, severity and what treatment (if any) you are receiving.

Does anyone in your immediate family have diabetes or thyroid conditions? Your immediate family is your biological parents, grandparents or siblings.
YesNo

Did you have any problems with a previous pregnancy or birth? (required)
YesNo
If yes, please provide more information

Have you received any prenatal care for this pregnancy? (required)
YesNo
Please tell us the healthcare provider's name. If no, please say 'no.'

Phone:

Fax:

Why are you seeking a midwife?

Have you been cared for by a midwife in the past?

If yes, what year: (if more than once, give the most recent year)

If you've had a midwife from our clinic, please tell us the name:

Do you prefer a specific midwife from our clinic? (leave blank if not). We can't guarantee that you will be assigned to this midwife due to holidays and availability.
Preference 1:

Preference 2:

How did you find us?

We treat the information gathered on this Intake Form with strict confidentiality. Please note: If we are unable to accommodate you, we will be sharing your name, date of birth and postal code with the Ministry of Health. This information is shared to demonstrate the need for more midwives in our community. Please notify us in writing if you do not want us to share this information.

You will receive a confirmation email to let you know that we have received your intake form. We will call you in the next 2-3 business days. If you don't hear from us or think your form has not been received, please follow up at 416-424-1976.