Welcome to Lincoln Community Midwives

REQUEST A MIDWIFE

Please fill out the requested information (below) for midwifery care by Lincoln Community Midwives.

You should receive an e-mail from our office administrator the next business day confirming receipt of your intake sheet.  If you do not get a confirmation e-mail, please call our office at 289-566-9350 to follow up.

Your date of birth:
Have you had a baby before?
How many times have you been pregnant?
How many times have you given birth?
How did you give birth (Check all that apply)?
Did you use a midwife?
If so, who? (Check all that apply):
Please name the midwives on your team and/or at your birth:
How long is your menstrual cycle (from the start of one period to the start of the next?
First day of your last normal menstrual period:
Estimated Due Date:
Where do you plan to have your baby?
Have you had problems with a previous pregnancy or birth?
Do you have a family doctor?
Family Doctor Name:
Family Doctor Phone:
Do you have any medical concerns that require you to see a medical doctor on a regular basis?
Do you take any prescription medications?
If you are interested in care please read our current COVID policies, found on our website.
After reading these policies, are you able to comply?
After reading this information do you understand that these policies may change as new information is provided?
Do you consent to sharing your information with the Ministry of Health?
In the event that we are unable to accommodate your request for care, we will send this information to the MOH (Ministry of Health). Letting the MOH know how many women were ‘unaccommodated’ goes a long way in helping to secure funding for midwives in the area - so that all women who request midwifery care are able to get it. The information shared with the MOH for this purpose is Name, Date of Birth, Postal Code and Due Date.
How did you hear about us?