BC Care Card (Personal Health Number) *
Date of Birth DD/MM/YY
Address including postal code
What pregnancy number is this for you?
How many babies have you given birth to?
Have you ever had a c-section?
If yes: VBAC or repeat CS?
Where would you like to give birth? Abbotsford / Chilliwack / Home
First day of your last menstrual period DD/MM/YY
How tall are you?
What is your pre-pregnancy weight ? (pounds)
Would you like an early dating ultrasound?
If you've already had an ultrasound what is your due date?
Name of your family doctor
How did you hear about us? (Go ahead name drop)
Let us know about any relevant medical or pregnancy information