The intake gives us a good picture

During the first meeting with the midwife, we will discuss your health and the health of your (eventual) partner. By completing the intake form before you come to this first appointment, we can already form a good picture of how we can provide you with the best care.

HELP WITH COMPLETING

    Basic information

    Menstrual cycle


    Notice :

    If it's not your first pregnancy, what are the birthdates of your other children? If the other pregnancies are with another midwifery practice, can you take the data to your first appointment?

    Medical history

    Notice :

    Did you answer yes to a question and do you want to expand your question? Eg. if you answered yes to "Have you ever had surgery?", tell us when and why you had surgery.

    Family history

    Notice :

    Did you answer yes to a question and do you want to expand your answer?