Community Midwives of Brantford Intake Form
If you would like to request care from our midwives, please fill out this form in its entirety. Fields indicated by a red star are required. Your request will be sent directly to us and our support staff will contact you if we are able to provide you with care.
If you would prefer to provide your details by phone or are experiencing difficulty with this form please feel free to contact us at: 519-751-6444.