Orientation Request

Congratulations on your pregnancy! We are excited that you have found us and are interested in pursuing care with our midwives. Please fill out this brief questionnaire and we'll add you to the Pacifica Orientation list on the date of your choice.

Name (first and last please)
Your answer
Partner Name (if applicable)
Your answer
Email Address
Your answer
Phone Number
Your answer
What is your due month or estimated due date?
Please know that we cap each month at 12 clients, but you are always welcome to join the wait list if we are full. It is not uncommon for spaces to open up for those on the wait list. If you want to be on the wait list, please sign up and come for an orientation ahead of time.
Your answer
Is this your first pregnancy?
Please note: We are unable to provide care for people with a previous c-section seeking VBAC (a vaginal birth after a cesarean). We are also unable to provide midwifery care for people who are pregnant with twins.
What type of insurance do you hold?
With our current licensing, we are not able to accept MediCal. We do not contract with any insurance companies. Our clients pay an up front fee and then file for reimbursement individually or with the assistance of our recommended third party biller. After the initial deposit, you are able to decide on a payment plan that suits your family's needs.
Your answer
How did you hear about us?
Your answer
Please tell us about any major health concerns that may affect your pregnancy.
Note that there are certain health issues that may necessitate care with a different provider. We will contact you if there is a reason that we may not be able to provide you with care at Pacifica.
Your answer
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