General Paediatric Consultation Clinic Referral Form PRINT 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by placing the patient sticker at the designated area on the form. This helps in identifying the patient easily.
3. Fill in the Patient Information section, including Date of Birth, Last Name, First Name, Gender, Guardians’ Names, Email, and both home and mobile phone numbers.
4. If an appointment is pre-booked, enter the Time and Date of the appointment. If not pre-booked, indicate the referral urgency by selecting Urgent, Semi-urgent, or Non-urgent.
5. Specify whether the patient has a primary care provider and provide their name if applicable. Indicate if a paediatric opinion or second opinion is needed.
6. In the Reason for referral section, attach any relevant SickKids ED Summary of Care documents as required.
7. Complete the Name of referring MD/NP and Billing Number fields before signing at the bottom of the form.

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