Intake Form


Questions asked will help to determine if Midwifery care is the best choice for you and your Baby. Please fill out information as is on your Health Care Card as Midwifery care is covered by your BC Care Card.

    If you are uncomfortable answering any of the questions below, they can be covered privately with your Midwife.
    If you are uncomfortable answering any of the questions below, they can be covered privately with your Midwife.

The material on this website is intended for information use only. Any individual with health concerns should contact their health care provider for a complete diagnosis. Do not depend solely on the content of this website for treatment.

Bellies To Babies
Midwifery Service
#5A 1009
Allsbrook Road
Parksville BC V0R1V0

Contact Us
Phone. 250-248-2482
Fax. 250-248-1084
Info@mymidwife.ca
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