Request Care

Please note that fields marked with * are REQUIRED to submit the form. If you reach the end of the form and the SUBMIT button doesn't seem to be working, make sure you have completed all required fields.

About you

Do you currently LIVE in Toronto? *

Yes, I live in Toronto and am planning to stay in Toronto Yes, I live in Toronto but am planning to move our of Toronto No, I am a visitor to Toronto I do not live in Toronto, but am planning to move to Toronto

About your pregnancy

How many VAGINAL deliveries have you had? *

How many CESAREAN deliveries have you had? *

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

Yes No

If yes, who was/were your midwives? *

Where would you like to give birth? *

Hospital Birth Centre Home Undecided

Community Midwives of Toronto can attend clients giving birth at:
St Michael's Hospital
Toronto Birth Centre
or
at you home

Additional Information

Do you have a Health Card (OHIP)? *

Yes I have OHIP I don't have OHIP, but I have UHIP, Interim Federal Health, or another insurance plan I do not have any health insurance

Do you have any plans for pain relief during labour? *

I am hoping for an unmedicated birth I am hoping for an epidural (only available in hospital) I need more information to make a decision

Have you had any problems with a previous pregnancy or birth? *

Yes No I have not been pregnant or given birth before

If you answered yes, please provide more information. *

Do you have any major medical complications such as diabetes, hypertension (high blood pressure), epilepsy etc.? *

Yes No

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

What language do you speak at home? *

Will you require a translator? *

Yes No I have a family member or support person who can translate for me

Please check if you would prefer a midwife who speaks: *

French Farsi Spanish Arabic

Indicating your preference does not guarantee that you will be assigned a midwife who is BIPOC or speaks your requested language, but we will do our best to accommodate your preference.
You can learn more about our midwives HERE

If you identify as Black, Indigenous, or a Person of Colour (BIPOC), please let us know if you would prefer to be cared for by a BIPOC midwife, or any particular midwife on our team. *

How did you hear about Community Midwives of Toronto *

Referred by another healthcare provider Referred by friend or family member Internet Search (e.g. Google) Association of Ontario Midwives or TBC website I am a past client

The Ministry of Health (MOH) asks us for some information about people seeking midwifery care to track the demand for midwifery care in Ontario. May we share your information with the MOH? *

Yes No

Request Care from Community Midwives of Toronto

About you

About your pregnancy

Additional Information