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Community Birth Program
at Village Health Clinic Inc.

Panorama Village Shopping Centre
#201 - 15149 Highway 10 and
#105 - 15153 Highway 10
Surrey, BC V3S 9A5
T: 604-575-7275
F: 604-574-7290


Women
Families
Community

How to register

The Community Birth Program is open to all who would like to deliver out of Surrey Memorial Hospital or are planning a home birth in Surrey, North Delta, or White Rock. If you would like to learn more about the program, please do not hesitate to call us 604-575-7275 or simply fill out our intake form and we will call you back within 3 business days to set up your first appointment.

Your initial visit will be a 45-minute appointment with a midwife or a nurse practitioner. She will order prenatal bloodwork and any required ultrasounds, review your health history with you and discuss what to expect during your care with Community Birth.

Please take care in filling out this form as accurately as possible; it will help us determine your care needs in advance of your visit.

Personal Information
Date of birth
DD
/
MM
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Contact Information
Medical Information
What was the FIRST day of your last period?
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MM
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YYYY
DD
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MM
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YYYY
Other Information