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Community Midwives of Toronto

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Please complete the form below to apply for care with Community Midwives of Toronto

Unsure of your due date? Use this tool to calculate your Estimated Date of Delivery.

* Indicates required field

Your legal name *

First

Last

Name you prefer to be called *

Pronouns *

Nearest major intersection to your home (We serve clients North to Highway 401; West to Islington Ave and East to Victoria Park) *

Your street address and city *

Are you a resident of Ontario planning to live here after the birth of your baby? *

Postal code (A1A2A2) No spaces *

Your phone number *

Your email address *

Is it OK to leave messages at this number? *

Language spoken at home *

Your Date of Birth (YYYYMMDD) *

Please follow the format listed!

Have you previously been a client at Community Midwives of Toronto? *

Do you have a Health Card (OHIP)? *

If yes, who was your midwife or midwives? *

Have you previously given birth? *

If yes, how many births? *

If you have given birth, what type of birth was it? *

Where would you like to give birth? *

Estimated due date (YYYYMMDD) per calculation above. *

Do you have plans for pain relief during labour? *

Do you have any major medical conditions, such as diabetes, hypertension, epilepsy etc? *

If yes, please provide more information about the condition and any medication you may be taking. *

Did you have any problems with a previous pregnancy or birth? *

If yes, please provide more information. *

Please check all that apply if you choose to self identify with any of these priority populations: *

LGBTTQQI2S Transgender, transexual, genderqueer, intersex Less than 19 years old at your due date Dis/ability Low income Refugee or immigrant Single parent Under/Unhoused Uninsured (no OHIP) Racial/cultural community Linguistic community Indigenous

If you self-identify as Black, Indigenous or a Person Of Colour (BIPOC) who would prefer to be cared for by a midwife of colour please let us know. We will try to accommodate these requests if we can. Availability of BIPOC midwife DOES NOT limit your eligibility for midwifery care. Please specify: *

Please check if you prefer a midwife who speaks: *

French Spanish Farsi

How did you hear about Community Midwives of Toronto? *

Why are you seeking midwifery care? *

Anything else you'd like to tell us? *

The Ministry of Health and Long Term Care is gathering information about people seeking midwifery care to track the demand for midwives in the province. May we give your information to the Ministry of Health for this purpose? Your information is kept confidential *

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Community Midwives of Toronto
344 Bloor Street West, Suite 201
Toronto ON M5S 3A7
t: 416-944-9366
f: 416-944-8013

We serve clients living within
the following catchment area:
North to Highway 401
South to Lake Ontario
East to Victoria Park Avenue
West to Islington Avenue

Watch: Choosing Home Birth
Read the Canadian Association of Midwives statement on Gender Inclusivity and Human Rights (09/2015).
Read about the Midwives' Fight for Pay Equity

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