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.

If your health care number is from a province other than Alberta, please include where it's from.
Date Of Birth *
Date Of Birth
Name *
Name
Address *
Address
Primary Phone *
Primary Phone
Secondary Phone
Secondary Phone
Estimated Due Date *
Estimated Due Date