top of page

Please get in touch! 

Do you have any questions? Are you interested in using our services? 

Fill in the request for care (form below) or send us your questions.

***You will not get a confirmation that your request has been sent, so if you don't hear within a couple of weeks, please call or email us to confirm receipt.  Once the midwives have a chance to review your request, someone will reach out to you. ***

Request for Midwifery Care

Applications for midwifery care are reviewed regularly. You will be contacted within two weeks about your request.

Name as it appears on your health card*

Preferred pronouns

Primary Language

Email Address

Cell phone number

Home phone number

Preferred phone number for us to contact you:

Street address*

Town*

Postal Code

What is your birth date?*

Health Card # and expiration date

First day of last menstrual period

Estimated due date

Do you have a 28 day menstrual cycle?

If not, how long is your cycle?

Name of family doctor or nurse practitioner

Is this your first baby?

If no, how many babies have you had?

Were they born on, before or after their due date?

If so, by how many days?

Do you have a serious medical condition?

Please list any medications you are taking

Have you ever been a client of Midwives of Muskoka?

If yes, who was your midwife and the year?

Have you ever received midwifery care from another practice?

Have you considered where you would like to deliver?

If Hospital, which one?

Have you had a previous c-section?*

If yes, are you planning another c-section?

Preferred pharmacy

Are you taking a prenatal vitamin?

Is there anything else you would like us to know?

Name (optional)

Email Address (optional)

Message*

Midwives of Muskoka

8 Ontario Street

Bracebridge, ON

P1L 2A7

Phone: 705-645-4011

Fax: 705-645-6634

Email: admin@midwivesofmuskoka.ca

Office Hours

Mon-Thurs: 8-4 pm

A midwife is always available to clients by pager for urgent concern

bottom of page