Intake Form

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Contact Information

If you are interested in becoming a client of Cambridge Midwives
please fill in our Intake Form. You will be contacted within 1 business day.
If you have not heard from us, please call the office at 519-624-9708
Thank you.

Medical, Pregnancy & Historic Information

(E.g., diabetes, heart disease, epilepsy, high blood pressure not
pregnancy related, kidney disease, or other.
Note: go no further if any of these are “yes”)

E.g., gestational diabetes Pregnancy induce high blood pressure, etc. Did you require any medication?

Cambridge Midwives is a teaching practice. Midwives often have a student following them.
Are you interested in a midwifery student sitting in on your visits?



Pregnancy ,Birth and Postpartum Care

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