Client Intake Form | Briar Hill Midwives

If you are interested in midwifery care please submit the following form.

Full Name *

Email *

Phone *

Address *

Have you had a baby before? * Yes No

If so, was it a vaginal birth? Yes No

First day of your last normal menstrual period *

Due date

Where do you plan to have your baby?

Are you a previous client of Briar Hill Midwives? Yes No

Tell us what appeals to you about midwifery care? *

Type the characters you see in the picture below

201, 3604 52 Ave NW Calgary, AB T2L 1V9
Office: 403.474.8260
Team 1 Pager: 403.213.7000 (for current clients only please)
Team 2 Pager: 403.213.1500 (for current clients only please)