If you are a care provider or social service provider looking to refer a client for birth doula or midwife services, please fill out this form. Please be sure that your patient or client has agreed to your referral and is expecting to be contacted by us.
If you are an individual seeking our services, please click here.

​A member of our staff will get in touch with your client within 5 business days of receiving your referral. Our policy is to contact clients directly twice by telephone and twice by e-mail before we close a referral.

    Refer a Patient or Client
    The following information assists us in determining if your client qualifies for free or reduced cost services through our programs. 
    ​Client information is kept confidential and shared only with WHMS staff. Please answer to the best of your knowledge.