Online referral form
The fastest route — submits directly to our office, with no printing or faxing. Takes about two minutes.
Patient Forms & Resources
Everything you need before your visit
Complete what you can online — it takes a few minutes and keeps your appointment running on time. Prefer paper? Download a copy, print it, and fax it back to us.
For Families
Start here
New to the clinic? Registration is the only form most families need.
For Referring Providers
Send a referral
For physicians, nurse practitioners and midwives. Mark the referral urgent if your patient needs to be seen sooner.
Printable PDF
Single page. Complete, sign, and fax to (519) 512-0051. Includes a QR code that links back to the online form.
What to include. Patient name, date of birth, OHIP number, address, phone and email; the reason for referral and whether it’s urgent; and your name, provider number, phone, fax and signature.
How To Submit
Three ways to get it to us
Online
Recommended. Submitted straight to the office, and nothing gets lost in transit.
Fastest optionFax
Send completed paperwork to (519) 512-0051. Use fax for anything containing health information.
rapidaccesspediatrics@gmail.com — for general and administrative questions only.
No personal or medical details by emailWe don’t use regular mail. Our office doesn’t send or receive documents by Canada Post, UPS or Purolator. Please use the online form, fax, or bring paperwork with you.
Before Your Visit
A short checklist
Five minutes of preparation keeps your appointment on time — and avoids charges that are easy to sidestep.
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Health card
A valid health card is required at every visit, in person and virtual. Without one you may be charged for the service, and we can’t book your follow-up.
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Medications & allergies
Bring a current list, including doses and anything bought over the counter.
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Confirm by text
Reminders go out by text and email. A text reply is required to confirm — unconfirmed appointments are rescheduled.
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For virtual visits
You’ll need a computer, laptop or phone with an internet connection, a camera and a microphone. Find a quiet, well-lit spot.
Still Have Questions?
Text us — we answer every message.
Not sure which form you need, or whether your child needs to be seen in person? Send us a text during clinic hours and we’ll point you the right way.