IMPORTANT:
Our phone lines are open from Monday to Friday from 1:30 p.m. to 4:00 p.m. We will respond to email requests within 24 business hours (Monday to Friday).
Keep in mind that a hospital card will be needed for your child on the date of his or her test. Hospital cards can be made in room B-122 of the hospital. The expiration date of the hospital card is written at the bottom, left-hand corner of the card.
Although we do our very best to respect appointment times, there may be delays due to higher-than-normal patient volume or urgent cases. We appreciate your patience and thank you for your understanding.
* Indicates required field
*Name of doctor who referred you to The MCH
*Please provide the name of the test requested (as indicated on the referral)
*Please indicate if your child requires one of the following tests as these require the patient be fasting Select a Test Glucose AC (fasting) No fasting required Pyruvate Triglycerides, cholesterol, HDL, LDL (Lipid profile) Vitamin A and E
The time required for certain age groups is: Children less than 1 year old: 4 hours Children 12-18 months old: 6 hours Children older than 18 months old: 12 hours
Fasting means no food or drink (except a few glasses of water) for the time mentioned above.
Name of doctor you were referred to (if applicable)
Is this your first visit to The MCH ? yes no
*Is this your first visit to this clinic ? yes no
*Child's last name
*Child's first name
*Date of birth Format : YYYY/MM/DD
*Age
*Health care card number
*Health care card expiration date Format : YYYY/MM
MCH Medical Record number (if known)(upper right corner of MCH red hospital card)
Address (street)
City
Province
Postal Code
*Home phone number
*Your last name
*Your first name
*Your relationship to patient
*Daytime phone number Ext.
*Alternate phone number Ext.
* Email address