Contact

Intake Form

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please tell us; the first day of your last period, your estimated due date, previous number of pregnancies, Date of Birth and Public Health Number *

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Our Clinic Location

Address

C1-7159 West Saanich Road
Brentwood Bay, BC. V8M 1P7

Public Transit: Buses # 75, 81, 82
Parking: There is one customer parking spot at the rear of the building, and free, on-street parking on W Saanich Rd.

Phone

(778) 351-4441

Fax

(778) 351-4442

Email

dandelionmidwifery@gmail.com

If you experience any technical problems filling out the Intake Form please phone or email our office.

We would love to hear from you.

Intake Form

Our Clinic Location

Address

Phone

Fax

Email