Prenatal Pathway

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By checking this box, you are giving permission for the Breastfeeding Buddies Program to receive this form via email and use your email address to communicate with you. While all precautions are taken to ensure security and privacy, email can be vulnerable to misuse. Please do not include any confidential health information on this form.

Your Due Date April 2024May 2024June 2024July 2024August 2024September 2024October 2024November 2024December 2024January 2025February 2025March 2025

We want to know who we're reaching! Please select the region where you live:
Waterloo RegionGuelph-WellingtonLambtonGTAHamilton/NiagaraOttawa/Northern OntarioOther

Where did you hear about our services? MidwifeObstetricianDoctor/NurseCommunity Healthcaring KWGrand River HospitalCambridge Memorial HospitalPublic Health Breastfeeding ClinicNorth/West Lambton CHCGuelph CHCMy Breastfeeding BuddySocial MediaWeb SearchFriend/FamilyOther

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