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.
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 firstname.lastname@example.org.
Fax number: (905) 390-3646
For your convenience, you can also obtain a free doctor's referral by visiting following virtual clinic: