Intake Form

Congratulations on your pregnancy!

If you would like to learn more about midwifery care please spend some time on our website, attend one of our upcoming Birth Information Sessions, or speak with Bronwyn, one of our administrators. Due to our busy clinic schedule it is not possible to book an interview appointment with our midwives.

If you would like to come into midwifery care please follow the instructions below to fill in an intake sheet. Please use the due date calculator to fill in the Estimated Due Date section of the form.

      1. You can attach the form (following the instructions below) to an email, or you can fax it to our clinic, or drop it off during our regular business hours. Our fax number is 519-954-8861.

Please note that these instructions do not work on any devices or ipads.

      1. Click on the Intake_Form link. This should open the form in a new tab.
      2. Click download and save the form to your computer
      3. Fill in the form with as much information as possible.
      4. Save the form under a new name (ie: Jane Doe Intake Form)
      5. Then attach the form in an email to our office. Our email address is info@blueheronmidwives.com

If those instructions don’t work, try these:

      1. Click on the Intake_Form link. This should open the form in a new tab.
      2. Fill in the form with as much information as possible.
      3. Click on print
      4. Click on printer destination and select “Change format”
      5. Choose “Save as PDF”
      6. Save the form to your computer.
      7. Then attach the form in an email to our office. Our email address is info@blueheronmidwives.com

The midwives discuss all possible intakes at our regular practice meeting on Thursday afternoon. Our administrator will be in touch on Thursday after the meeting to let you know if you have been accepted into care or added to our wait list.

If you have any questions or are having difficulty filling out the form please call our office during our regular business hour: Monday to Thursday 9am to 12pm & 1pm to 5pm, Friday 9am to 12pm.