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, or Midwife. Referral must be issued to your baby's name and to be addressed to Latched On Paediatric & Breastfeeding Services. 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
Referred to: Latched On Paediatric & Breastfeeding Services
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 clinics: