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Apply for Midwifery care
If you'd like to apply for midwifery care, please fill out the form below.
Preferred Name (What do you like to be called? If you have a preferred pronoun, you can also add that here).
Full Name (First, Middle, Last - As it appears on your BC Services Card)
*
Age at Estimated Date of Delivery
*
Street Address
*
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Email Address
*
Phone
*
Which is the best way to contact you during the day?
*
Primary Phone
Email
Is it okay to leave a message at this number?
Yes
No
Height (cm)
*
0 / 50
Weight (kg)
*
0 / 50
Occupation
Partners Full Name (if applicable)
Partner's Phone Number
Family Doctors Name
First day of your last menstrual period:
*
Estimated Date of Delivery (Need help? Copy and paste the following link http://www.perinatalservicesbc.ca/health-professionals/professional-resources/edd-calculator
*
Have you seen a doctor at all this pregnancy? What have they ordered? (Check any that apply)
*
Ultrasound
Labwork
I haven't seen a doctor
Is this your first baby?
*
Yes
No
If no, How many times have you given birth Vaginally?
If no, How many times have you given birth by Casarean?
Please share about your previous birth experiences, if applicable:
Registered midwives attend births in hospital and at home. Where are you planning to have this baby?
*
Hospital
Home
Undecided
Have you had previous midwifery care?
*
Yes
No
If Yes, which practice?
Was a midwife from Sage Hills Community Midwives in attendance at any prior births? If so, Who?
Checkbox
*
Pre-existing Hypertension
Pre-existing Diabetes
Grave's Disease
Kidney Disease
Cardiac Disease
Seizure Disorder
None of the above
Why are you interested in Midwifery care?
0 / 500
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Contact Us Today
If you wish to apply for Midwifery Care please click the 'Apply now' button above. For all other enquiries please send us an email.
info@sagehills.ca
250-828-0055
250-434-2525
#208-300 Columbia St.
Kamloops, BC V2C 6L1
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