Northern Midwifery Care
Your Name (Required)
Email Address (required)
Home Phone Number
Have you had any care in this pregnancy yet?Not Yet
Yes, Family Doctor
Yes, Walk in Clinic
Yes, an Obstetrician
Yes, another Midwife
Self Care
When is your baby due?
To confirm your due date, when was your last menstrual period?
This is baby numberOne
Two
Three
Four or more
NNCC offers the option of collaborative care, with a Doula to provide optimal care. This is optional, you may choose to add a Doula to your birthing team or not it is up to you. I would like more information about this option
I am interested in collaborative care with a Doula
I don't know if I would like Doula care
I am a previous client & unsure about this option
Doula Services are not covered by our Medical Services Plan.NMC believes nobody should be without Doula support due to financial concerns and has recieved funding for those who need it (no questions asked). I can afford to pay for Doula Care
I can afford to pay partial payment for a Doula
I would like a Doula, and finances are an issue
I don't know if I want a Doula as part of my care
If you know a Doula that you would love to include as part of your birth team, what is her name?
How did you hear about Midwifery care? Family Member
Friend
Past Client
Phone Book
Search Engine
Advertising
Other
Facebook
Any further questions, comments or information you would like to provide?
