Appointment with a specialist

To request an appointment with a specialist, please fill out the form below. Incomplete applications will not be processed. Wait times depend on the priority assigned to the referral and may take up to several months.  


  • If you are looking for a pediatrician, please visit this link.

For any questions, please call the Appointment Referral Centre at 514-412-4040 or contact us at [email protected], with the following information: 

  • Name of child 

  • Two telephone numbers where you can be reached during office hours (8:00 a.m. to 4:00 p.m.) 

  • Clinic / specialty you are requesting an appointment for 

  • Your doctor’s referral uploaded as an attachment, if this is a first appointment in the clinic

In case of an emergency, contact your family physician, call 811, or go to the nearest Emergency.



1. If this is your first visit to the clinic you are being referred to, fill out this section. If it is for a follow-up, start at section 2.
Please make sure your attachment is clear and legible. Documents that are blurry, dark or extremely large or small will not be accepted. Please note that if you do not attach your referral, you will be asked to fax it to the department directly. No appointments are provided without a copy of the referral. To obtain the fax number of the department you are being referred to, please consult our directory:
Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf doc docx.

Photos of documents are not accepted

2. Return visit
3. Patient Information
(upper right corner of MCH red hospital card)
4. Contact Information (for parent or guardian)