Please pick a date so we know when to expect you.
Name *
(first and last please)
Partner Name
Partner Name
(if applicable)
Phone Number
Phone Number
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.
* 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.
We are not able to accept MediCal and we are not contracted with any insurance companies. Our clients pay an upfront fee and we bill the insurance company to obtain a retroactive reimbursement. A sliding scale and payment plans are available to our clients.
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.