Dr Jack Newman - Breastfeeding Help and Lactaion Consultant Training  
Referral Forms Print E-mail

Please Note: . You will need a referral from a physician or midwife. Ideally there should be two separate requests one for the baby and one the mother.  The baby can be referred by a physician or midwife, the mother only by a physician.  We really appreciate getting a referral for both mother and baby, but if it is not possible to get a referral for both the mother and baby and only one referral is possible, we must have the referral for the baby. If you have not already obtained valid referrals, please do so prior to your appointment date and time. The referral note(s) should be faxed to our clinic at (416) 498-0012 prior to your appointment.

Referral Form for Baby | Referral Form for Mother

All of our information sheets may be copied and distributed without further permission on the condition that it is not used in ANY context that violates the
WHO International Code on the Marketing of Breastmilk Substitutes (1981)
and subsequent World Health Assembly resolutions.

If you don’t know what this means, please email us to ask!