Doctor’s, Nurse Practitioner’s, or Midwife’s referral forms

*Get a Referral

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

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


Patient: Baby's First Name, Last Name
Referred to: Ontario Breastfeeding Network
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. For speedier service, please ask them to complete the Online Referral Form. Fax forms take much longer to reach us.


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