Intake form

Fill out our English intake form below or try the formulario de admisión.

    Full Name

    First name on OHIP or legal documents (required)

    Last name on OHIP or legal documents (required)

    Have you had a midwife from our collective in the past?
    YesNo

    If yes, what year: (if more than once, give the most recent year)

    If you've had a midwife from our collective, please tell us the name:

    What are your pronouns? (her/him/they or another pronoun)

    Language spoken at home

    Your date of birth (required)

    Major street intersection where you live in Toronto. (We service the area North to HWY 401, East to Woodbine Avenue, South to Lake Ontario, and West to Royal York Road)

    Street address (required)

    Postal code

    Please enter your phone number (required)

    Please know that your phone's call display may show "Midwives Collective of Toronto" when we call.

    Emergency Contact (please include name, relationship to you, phone number, and address, if different from above)

    We have new midwives join our team every year. Are you open to meeting one of these midwives?
    yesno

    Are you comfortable having a midwife with a student involved in your care?
    yesno

    If you answered "no" to both having a new midwife and having a student then it is unlikely that we will have a midwife available for you as we are a very active teaching practice and all of our experienced midwives work with students.

    Your Email

    When is your estimated due date? (required) - Need help calculating your due date?

    Unable to estimate your due date to the nearest month

    When was the first day of your most recent menstrual period (LMP)? Please note that we are unable to process your form without an LMP or due date.

    Not sure about your last menstrual period

    How many vaginal births have you had? (required)

    How many C-section births have you had? (required)

    Do you have any major medical problems like diabetes, hypertension, or epilepsy? (required)
    YesNo

    If yes, please provide more information

    Did you have any problems with a previous pregnancy or birth? (required)
    YesNo
    If yes, please provide more information

    Where do you plan to have your baby? (required)

    Do you have plans for pain medication during your labour?

    Why are you seeking a midwife?

    The Midwives Collective of Toronto is committed to increasing access to midwifery care for communities historically underserved in healthcare. This includes 2SLGBTQIA+, Indigenous, Black, racialized, recently immigrated (regardless of documentation/refugee status), religious minorities, homeless/under-housed, youth, living with disability, having language barriers, need for trauma informed care etc.

    Is there anything you want to tell us about how you identify or who you want your midwives to be? The information you share is used to connect you to a midwife you identify with. Not sharing additional information will not impact access to a midwife. We try our best to match you as closely as possible to your request, however not all requests can be met.

    The Ministry of Health asks us for some information about people seeking midwifery care to track the demand for midwives in the province. May we give your information to the Ministry of Health?
    YesNo

    Please understand that demand for midwives is very high. If we contact you to book an appointment with a midwife, we require your response to our call or email. Please agree that you understand, if we have not heard from you within the window of time given, the offer of midwifery care cannot be guaranteed.
    Please accept by checking here:

    MCT has an adaptive mask wearing policy to protect our vulnerable population of pregnant people and their babies. You may be asked to wear a medical mask while receiving midwifery care in any location, including your home.
    Please accept by checking here:

    We'll contact you at the email address you've provided above to let you know that we have received your intake form. If you do not receive that confirmation email in the next 2 business days, please check your spam/junk mail or follow up at 416-963-8842 info@midwivescollective.ca