Plum Midwifery

Accepting new clients!
Early booking is advised.

We would like to invite you to set up an initial appointment with us to find out what your birthing options are in the Comox Valley.   Join us to find out what your birthing options are for hospital births, home births and home water births. There are so many questions you may have and here is the place to come find out what will suit you and your family. Your first visit with us is an information session. Please visit "our clinic" page to find out more and to book an appointment with a midwife. Midwifery has now been regulated in BC since 1998 and midwifery services are completely covered by your medical services plan.

New Client Registration

*First Name    *Last Name
*Street Address 1
 Street Address 2
*City
*Province    *Postal Code
*Telephone (home)     (work)
*E-mail address
*Birthdate - Day:    Month:    Year:
*PHN (Care Card Number)
Age      Height

Number of:
*Pregnancies (including current)     *Children

Length of Menstrual Cycle
*LMP (dd/mm/yyyy)    *EDD (dd/mm/yyyy)
*Intended Place of Birth

Family Physician
Blood Group     RH
Allergies

Referred by

*indicates a required field. Please write n/a if you do not know.


            

 

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