Midwifery Interview Information
If you are filling this out from a link on our website, then we will call you after you submit this survey to schedule.  If you have already scheduled your appointment then these questions will give the midwives some background information to prepare for your interview.
Name *
Email (may be other than your google email)
Phone number *
Have you had a baby previously?
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What is your due date (if you know that already)?
Are you already getting care somewhere for your pregnancy?
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Where are you interested in giving birth?
Have you had a cesarean or other uterine surgery?
What insurance plan do you have?  Or do you intend to pay out of pocket?
Do you have any concerns that you might not be appropriate for an out of hospital hospital birth?  If so, what are they?
How far do you live from the birth center?
What else do you wish the midwives to know about you?
Have you already scheduled an interview with us?
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