203-1257 4th Ave, Prince George, BC
Meet the Midwives
New Beginnings Midwifery Intake Form
Please fill out this online intake form, or to call my office at (236) 423-0834. All intakes are reviewed and my office will get back to you within a week to advise you whether there is space available. Please be assured that your information will be kept confidential.
Best Phone Number To Reach You At
Date of Birth
Care Card Number (if possible)
First Day of Last Period (If Known)
When Is Your Baby Due?
Number of Previous Pregnancies
If this is not your first baby what type of births have you had?
Forceps or Vacuum
Where do you plan to give birth?
Describe any pre-existing health conditions or pregnancy complications that may affect your care:
How Did You Hear About New Beginnings Midwifery?
Referred by a Friend
Do you know anyone who has had care from us? If so who?