Meet the Calgary Midwives
Hilary Field
Sharyne Fraser
Anne Leblond
Peggy Maudsley
Janna Miller
Nadine Mitchell
Taina Turcasso
Tamara Litun – Clinic Admin
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Intake Form
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Intake Form
Please fill out the form below and we will get back to you within 48-72 hours.
Your Full Name: (required)
Your Partner's Name:
Your Email Address: (required)
Your Phone Number: (required)
Your Address:
Are you in the Calgary or Canmore Area?:
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Calgary
Canmore
Have you had a baby before?
Yes
No
If so, was it a vaginal birth?
Yes
No
Did you use a midwife?
Yes
No
First day of your last normal menstrual period: (dd-mm-yyyy)
Estimated Due Date: (dd-mm-yyyy)
Where do you plan to have your baby?
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Home
Hospital
Birth Center
I don't know yet
Do you have any medical concerns that require you to see a medical doctor on a regular basis?
No
Yes
Do you take any prescription medications?
No
Yes
If you answered yes to either, please briefly elaborate (all responses are confidential):
Are you a smoker?
No
Yes
Please tell us what appeals to you about midwifery care and any questions you may have for the midwives?