A Dedicated Pregnancy Clinic Improves Reproductive 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Referring Physician Info section. Enter your name, practice ID, specialty, phone number, and fax number accurately.
3. Next, complete the Patient Info section. Provide the patient's first and last name, PHN/OHIP number, date of birth (DD/MM/YY), address, and email.
4. In the Reason for Referral section, describe the purpose of the referral using either the free text box or check boxes provided.
5. Indicate the Gestational Status by selecting whether the patient is pre-conception or pregnant and fill in the expected due date (EDD) if applicable.
6. Complete the IBD History section by selecting the diagnosis type and listing any medications. Also indicate if this is a multifetal gestation and whether there are any flare-ups.
7. Finally, ensure that you attach copies of any relevant laboratory tests or investigations before submitting your form via fax or email.

Start using our platform today to streamline your document editing and submission process for free!