Request an Appointment

At the Children’s, we aim to provide patients access to a specialist as quickly as possible. Given varying volumes, however, the wait time you experience before we contact you for an appointment may vary given the priority assigned to your child’s referral. Rest assured that you will be contacted for an appointment within the time delay corresponding to the priority. This may take up to several months. Should you have any questions about the status of your appointment request, please contact the Appointment Referral Centre at 514-412-4040 or contact us by email at: [email protected]

Please do not use this form for the following services:

Important: If your child has a medical emergency do not use this form.

In case of an emergency, contact your family physician or go to the nearest CLSC or Emergency. Please do not use this form if the specialty you are looking for is not indicated on the list. Do not use this form if you are looking for a pediatrician. A list of pediatricians in your area can be found at

Should you contact us by email, make sure to provide us 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 given clinic 

Please note that incomplete applications will not be processed.

* Indicates required field

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)