Client Intake Form

Clinic Reception Hours

To book appointments, our administrative staff can be reached during the following hours.

Monday – Thursday: 9:00am – 4:30pm

Tel: 519-664-2542


Mailing address:
St. Jacobs Midwives
P.O. Box 190
9 Parkside Drive, Unit 2
St. Jacobs, Ontario, N0B 2N0

Please note: Our service area includes Kitchener, Waterloo, and Woolwich Township as well as parts of Wellesley and Wilmot Townships

Fax: 519-664-1815

Pregnant and looking for care? Contact us as soon as possible to check for availability.

If you are interested in becoming a client of St. Jacobs Midwives, please complete Intake Form below. When our administrator calls you within 3-5 business days, they will record more detailed information. Due to high demand, space is limited and may not be guaranteed.

Please be aware that any information sent on a form (email) may not be secure. Any information you provide will be stored in accordance with our Privacy Policy and the privacy standards for Ontario.