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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
Province
Postal Code
Email Address
Which is the best way to contact you during the day?
Primary Phone
Email
Height (cm)
Phone/Mobile
Is it okay to leave a message at this number?
Yes
No
Weight (kg)
Occupation
Partner's Full Name (if applicable)
Partner's Phone Number
Family Doctor's 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?
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 cesarean?
Please share about your previous birth experience, 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?
Do you have any of the following:
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?
Apply for care
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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