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Coming August 2023

Intake Form

All information entered on this form is strictly confidential and will be treated as such regardless of whether you are offered midwifery care. The midwives and our receptionist will be the only individuals to review this information and it will not be shared with any third parties. You may leave any questions blank that you wish. In the event we are able to offer you midwifery care, you will be provided with a detailed health questionnaire at your initial appointment.

Contact Information

We believe that midwifery care, with its longer appointments and relationship-based care, is uniquely suited to meeting the needs of members of communities who may experience marginalization or difficulty when accessing medical care. Therefore, where possible, we prioritize providing care to these individuals. If you wish, please let us know if you identify as a member of any of the following communities:

Pregnancy Information

The following questions relate to your pregnancy.

Midwifery Care

These questions relate to Midwifery Care specifically

Health Information

The following questions relate to your health information

Thank You

Thank you for completing an Intake Form and for your interest in midwifery care at First Light. We will get back to you with a response as soon as possible and within no more than two weeks of receiving your application. In the event that we are not able to provide you with care in your current pregnancy, you can be added to our waitlist and we hope to be able to offer you care in a future pregnancy.