IMPORTANT: Due to COVID-19 partners and children will NOT be allowed in the clinic.

Intake Form

Our practice provides service to women living in Oakville, Milton, west Mississauga and Burlington.

Street Address 1Street Address 2CityState / ProvincePostal / Zip CodeCountry
Attention: Please add our email address "midwivesofhalton@gmail.com" to your address book or to your list of trusted senders to avoid missing important emails from us.
Enter Numbers between 20 - 45
Cm or
Feet and Inches
KG or
LBS
(gravida)
(para)
Yes No
Yes No