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POSTPARTUM-ONLY CARE REQUEST FORM

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Please make sure the information you provide in this form is accurate. This is the request form for POSTPARTUM-ONLY CARE. If you would like to request for FULL MIDWIFERY CARE, please click here.

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After you submit this request form, we will contact you once you are accepted under our care. 

Date Of Birth
Year
Month
Day
Baby's Estimated Due Date
Year
Month
Day
Baby's Birthday
Year
Month
Day
Are you a previous client of Solé Midwifery Care (Negar Aghtouman)?
Yes
No
Call: (604)312-3515
Fax: (778)312-1234
Address: 202-301 East Columbia Street, New Westminster, BC
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At Solé Midwifery Care, we acknowledge with deep respect and gratitude that we live and work on the traditional, ancestral, and unceded territories of the Qayqayt First Nation, as well as the broader Coast Salish peoples, including the Musqueam, Squamish, and Tsleil-Waututh Nations.

We recognize the ongoing presence and stewardship of Indigenous peoples on these lands, and we are committed to providing care that is rooted in respect, humility, and cultural safety. We honour the histories, languages, and cultures of the First Peoples and strive to support reconciliation through our midwifery practice.

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