Your first step to great maternal care.

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If you are pregnant and are interested in midwifery care, please complete our intake form. A WEM administrative staff will get back to you within a week to let you know if we have a midwife available for you due date.

Please complete the form below

Name *
Name
Date of Birth *
Date of Birth
OHIP *
Midwives can care for anyone that lives in Ontario regardless of immigration or health insurance status. If you do not have Ontario health insurance (OHIP), don’t worry - a member of our intake team will call you within one week.
Phone Number *
Phone Number
Address *
Address
Address Major Intersection
Partner Name *
Partner Name
Partner Phone Number *
Partner Phone Number
Emergency Contact Name
Emergency Contact Name
If different from partner.
Emergency Contact Phone Number
Emergency Contact Phone Number
If different from partner.
Estimated Due Date *
Estimated Due Date
If you need help calculating this, please visit the following link https://www.pregnancyinfo.ca/your-pregnancy/healthy-pregnancy/due-date-calculator/, then type in your result below.
If yes, explain
If yes, explain
If yes, explain
Have You Had A Baby With West End Midwives Before? *