Intake Form

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