Referral Form to be filled out by a Medical Doctor, Nurse Practitioner or Midwife

*Get a Referral

A referral is required for your initial OHIP covered appointment booking.

Please get a referral from your Family Doctor, Pediatrician, Nurse Practitioner, OBGYN, or Midwife. Referral must be issued to your baby's name and to be addressed to LatchedOn Paediatrics. In case of multiples, each baby must have their own referral or all babies' info must be on the same referral.

If you're in need of our services and getting the referral will take some time, please proceed with booking your OHIP-covered visit with us and let us know you need our assistance with the referral.


Patient: Baby's First Name, Last Name, Date of Birth, OHIP number
Referred to: LatchedOn Paediatrics
Referring Practitioner's OHIP billing Number: XXXXXX

*We reserve the right to refuse services because of an incorrectly issued referral.

Bellow is a short referral form to be submitted by a Doctor, Midwife, or Nurse Practitioner. Please share it with your healthcare provider. If you have your referral already, please email it to us at

Fax number: (905) 390-3646


For your convenience, you can also obtain a free doctor's referral by visiting following virtual clinic: