BECOME A CLIENT
Online Intake Form
Congratulations!
We book clients in based on a a number of criteria, so please fill in all of the information below. Please note, by filling out this intake form this does not guarantee a spot will be available for your due date. Please allow 7 business days to receive a response. We will respond via email, so please be sure to check your email.
Clinic is from Tuesday to Thursday and times offered vary on your Midwives schedule. Typically, appointments are between the hours of 8:00am and 5:00pm
Currently we do not accept clients over the phone or through our general email. If you have questions about Midwifery Care, please be sure to read through our website. If you had additional questions, please give our office a call.
PLEASE NOTE THAT WE ONLY DELIVER AT MARKHAM STOUFFVILLE HOSPITAL
IMPORTANT INFORMATION
It is important that all the information you provide below is true and accurate. Midwives have a scope of practice in which there is criteria clients need to meet. This questionnaire is to determine if having a midwife is suitable for your pregnancy.
Providing false information to become a client is unacceptable and will result in the automatic ineligibility to become a client.