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 Clinic Coordinator directly at 604-874-7999.


Name *
Home Address *
Home Address
Estimated due date (if known)
Estimated due date (if known)
First day of your last menstrual period: *
First day of your last menstrual period:
Request a particular midwife or tell us anything else you think we should know
Do you have a BC Care Card? *

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