Midwifery care is self-referred. You do not need a referral to request space with a midwife. 

In order to match you with a suitable team of midwives, we would like to learn more about you. 

You may choose to fill out this online form, or to call and speak with our Office Administrator directly at 604-874-7999.


Name *
What is your date of birth? *
What is your date of birth?
Home Address *
Home Address
Please note that we prioritize Vancouver area clients. If you live out of area and want to find Midwives in your community please go to bcmidwives.ca
Estimated due date (if known)
Estimated due date (if known)
First day of your last menstrual period: *
First day of your last menstrual period:
You will register at a hospital regardless of if you plan to birth there or at home.
Have you already seen a care provider who ordered blood work and an ultrasound? Were you referred to a specific Midwife by a previous client of ours? Do you have any unique needs we should know about? Do you plan to move during pregnancy? If so, where to?
If you have, how many times and did you have vaginal births and/or cesarean sections?

Thank you for your interest in Pacific Midwifery. We look forward to meeting you.