MHB - consultation request

Part 1: Personal details
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Prospective parents may use this form to request a private consultation with one or more providers* who participate in our Gay Parenting Assistance program (GPAP).** Once you submit this information we will forward it to the slected providers and they will contact you to coordinate a consultation in person or via phone / Skype. Your information will remain confidential and only shared with the service providers you indicated (but first you will receive a confirmation email to verify that you indeed submitted this request). 
Note that you do not need to be approved for benefits to reach out to providers through this form - anyone can take advantage of this universal form to reach out to multiple services providers in one step!

* You can see the updated list of participating providers here.
** For more information about GPAP see here.

 

1. Prospective parent #1
Please provide full legal name.
Calendar
Do you identify as: *This question is required.
2. Do you plan to have children as: *This question is required.
Prospective parent #2 *This question is required.
Please provide full legal name
Calendar
Are you legally married?
3. Have you been approved for GPAP Stage I benefits?
Note that you do not need to be approved for benefits to reach out to providers through this form.
If you have not applied to our assistance program you can do so at any time on our website!


With which of the following agencies and / or clinics would you like to request a private consultation?
Please note that we do not recommend reaching out to more than 8 providers. *This question is required.
* 2016 discount units exhausted. You may ask the provider regarding timing for 2017 discounts.​
How did you have your previous children (check all that apply)?
If you already have children through surrogacy, don't forget to fill our MHB Parent survey!
5. What type of surrogacy are you pursuing / considering?
6. Languages you (or your partner) speak: