Request for Midwifery Care

Congratulations on your upcoming birth and thank you for your interest in care with Briar Hill Midwives. To be considered for care with our practice, you will need to complete the form below AND submit a Request for Care through the Alberta Association of Midwives.

If you have any questions about the request for care process, please make sure to check out our FAQs.

I have completed the provincial Request for Care form (link above) *
Name *
Primary Phone *
Primary Phone
Secondary Phone
Secondary Phone
Address *
First day of your last menstrual period (LMP) *
First day of your last menstrual period (LMP)
Estimated Due Date *
Estimated Due Date