Quotation Estimate Midwife in Canada Vancouver –Free Word Template Download with AI
Professional Midwife Services — Canada Vancouver
Document Reference: QE-MW-2025-04172
Midwife Practice Details
Practice Name: Pacific Northwest Midwifery Collective
Lead Midwife: Sarah Chen, R.M. (Registered Midwife)
Address: 1247 West Broadway, Suite 302, Vancouver, BC V5Y 1E3, Canada
Phone: (604) 555-0187
Email: [email protected]
CMBC License No.: MW-2019-4482
Client / Recipient Information
Client Name: [To be completed]
Address: [To be completed], Vancouver, BC, Canada
Phone: [To be completed]
Email: [To be completed]
Insurance Provider: [To be completed]
Policy / Member No.: [To be completed]
This Quotation Estimate outlines the comprehensive midwifery care package provided by our registered Midwife team operating within the Canada Vancouver metropolitan area. All services are delivered in accordance with the standards set by the College of Midwives of British Columbia and are fully covered under the Medical Services Plan (MSP) of British Columbia where applicable. The Midwife will provide continuous, evidence-based care from the first trimester through the postpartum period, ensuring the client receives personalized, culturally sensitive support throughout the pregnancy journey in the Canada Vancouver region.
| # | Service Description | Frequency / Duration | Unit Rate (CAD) | Estimated Total (CAD) | MSP Coverage |
|---|---|---|---|---|---|
| 1 | Initial Prenatal Consultation & Risk Assessment by Midwife | 1 session (90 min) | $185.00 | $185.00 | Fully Covered |
| 2 | Routine Prenatal Visits with Midwife (including fetal monitoring, bloodwork coordination, and growth tracking) | 12 sessions (60 min each) | $145.00 | $1,740.00 | Fully Covered |
| 3 | Ultrasound Coordination & Referral Management (Canada Vancouver diagnostic centres) | 3 referrals | $95.00 | $285.00 | Partially Covered |
| 4 | Birth Plan Development & Education Workshop (led by Midwife) | 2 sessions (120 min each) | $120.00 | $240.00 | Fully Covered |
| 5 | Labour & Delivery Attendance by Midwife (hospital or home birth in Canada Vancouver) | 1 event (up to 24 hrs) | $1,200.00 | $1,200.00 | Fully Covered |
| 6 | Postpartum Home Visits by Midwife (newborn assessment, breastfeeding support, maternal recovery check) | 4 visits (60 min each) | $130.00 | $520.00 | Fully Covered |
| 7 | 24/7 On-Call Midwife Support Line (Canada Vancouver coverage area) | 9-month subscription | $45.00 | $405.00 | Fully Covered |
| 8 | Administrative & Record-Keeping Fees (file management, referral letters, MSP billing) | Flat fee | $150.00 | $150.00 | Not Covered |
| 9 | Emergency / After-Hours Midwife Call-Out (if required, Canada Vancouver area) | Estimated 1 call | $250.00 | $250.00 | Partially Covered |
| TOTAL ESTIMATED QUOTATION (CAD): | $4,975.00 | ||||
| Estimated MSP / Insurance Reimbursement: | -$4,225.00 | ||||
| CLIENT OUT-OF-POCKET ESTIMATE (CAD): | $750.00 | ||||
- This Quotation Estimate is valid for thirty (30) days from the date of issue. After the expiry date, the Midwife practice reserves the right to revise fees based on current Canada Vancouver healthcare cost adjustments.
- All Midwife services listed herein are provided by a Registered Midwife (R.M.) in good standing with the College of Midwives of British Columbia. The Midwife maintains a minimum of $5,000,000 in professional liability insurance.
- Services are delivered within the Canada Vancouver service area, including the City of Vancouver, North Vancouver, West Vancouver, Burnaby, Surrey, and surrounding municipalities within a 40-kilometre radius of the practice location.
- Should the pregnancy be reclassified as high-risk during any prenatal visit, the Midwife will issue a supplemental Quotation Estimate for additional specialist consultations and may refer the client to an obstetrician at a Canada Vancouver hospital.
- Payment for out-of-pocket amounts is due within thirty (30) days of the final postpartum visit. A 1.5% monthly late fee applies to overdue balances.
- This Quotation Estimate does not constitute a binding contract. A formal Service Agreement will be executed upon the client's written acceptance of this estimate.
- All personal health information collected by the Midwife is protected under the Personal Information Protection Act (PIPA) of British Columbia and the federal Privacy Act of Canada.
- Cancellation of scheduled Midwife appointments must be made at least 48 hours in advance to avoid a $50.00 no-show fee, except in cases of medical emergency.
By signing below, the client acknowledges receipt of this Quotation Estimate for Midwife services in Canada Vancouver and agrees to the terms outlined above. The Midwife practice will commence scheduling prenatal appointments within five (5) business days of signed acceptance.
Client Signature: ___________________________
Printed Name: ___________________________
Date: ___________________________
Midwife / Authorized Representative: ___________________________
Printed Name: Sarah Chen, R.M.
Date: ___________________________
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