Thank you for your interest in Solstice Midwives

Once we receive your intake form, we will get back to you soon (within 1-3 business days), to book an intake appointment with one of our midwives!

Intake Form

First Name

As it appears on your BC MSP (Care) Card

Last Name

As it appears on your BC MSP (Care) Card

Preferred Name

If you prefer to be called a different name than the one on your care card, please let us know above.

Address

City

State/Province

Zip/Postal

Country

Address

Phone

Date of Birth

Personal Health Number

This is your Care Card number

Do you identify as Indigenous, First Nations, or Metis

Yes

Preferred Pronouns Preferred Pronouns

If applicable

If you are human, leave this field blank.