Appointment Request

WE ARE NOW BOOKING FOR SEPTEMBER 7^TH AND BEYOND

****The Clinic will be closed from Thursday August 19 until Tuesday September 7, 2010. Your emails or phone messages for appointments may not be responded to during this time.

If you have a breastfeeding question, you can contact Dr. Jack Newman and Edith Kernerman by clicking on the “Contact Us” link in the top right corner of the website.****

There is also a list of other breastfeeding clinics and private consultants below who you may contact for help. ****

Below is a list of private consultants who work in the Toronto area.

Suzanne MacKinnon, B.A. , IBCLC, NBCI Staff, mackinnonsuzanne@rogers.com 905-668-2906 (Durham and beyond)

Shery Leeder IBCLC, NBCI Staff, 647-214-1254/416-693-2456 (Toronto)

Cindy Battaglia, NBCI Staff, 416-819-5018 (Toronto)

Dallas Parsons, 647-519-6150, dallas@newgrowthnutrition.com www.newgrowthnutrition.com (Toronto)

Lynda Kirby RN, LCCE, IBCLC 416-846-1553 kirby.6@rogers.com (Toronto)

Jean Kouba RN, IBCLC jeankouba@cogeco.ca 905-844-8946 - www.haltonbreastfeeding.com (Oakville and Halton region)

Marla Blankenstein RN, IBCLC mblankenstein@rogers.com 416-433-9495

Shelly Plewes, B.A. , IBCLC splewes@gmail.com 416-422-3758 / cel-416-278-2434(for urgent issues) (Toronto)

You can also contact these clinics for help:

Victoria Park Breastfeeding Clinic 1214-1448 Lawrence Ave East(at Victoria Park) 647-344-5990

Betterbreastfeeding 491 Eglinton Avenue West Toronto (Eglinton and Avenue) 416-782-6111 betterbreastfeeding@hotmail.com

Toronto East General Hospital (416) 469-6667

Black Creek Community Health Centre (Jane/Finch area) (416) 249 8000 ext 2253 ask for Ruth Bacon ruthmbacon@rogers.com

Appointment Request

Please note: Due to lack of government funding, we have been forced to implement a pay-per visit policy to cover the administrative costs for your appointment. For appointments, there will be a fee of $50 for every visit. This fee is payable by cash or cheque only. If you are experiencing financial difficulties and require this fee to be waived, please contact us. We will not refuse any patients who cannot pay. At the clinic you will be seen one on one in your own room. *You will be seen by a lactation support person and by the pediatrician on staff that day: Dr. Jack Newman or Dr. Hilary de Veber or Dr. Leah Roth, and Edith Kernerman*.
Clinic Location
Clinic location for appointment:
Patient Information
Baby's First Name:
Baby's Last Name:
Baby's Health Card Number:
Baby's Health Card Version Number: If available
Baby's Date of Birth dd/mm/yy:
Baby's Gender:
Baby's Age:
Mother's First Name:
Mother's Last Name:
Mother's Health Card Number:
Mother's Health Card Version Number: If available
Mother's Date of Birth dd/mmm/yy:
Name of Hospital:
If you gave birth at home, enter "Home Birth" Please ask your physician or midwife FOR A REFERRAL TO BE SEEN AT OUR CLINIC. Have them fax their referral to 416-498-0012. Your doctor may suggest that you do not require a referral to our clinic. Please inform your doctor that a referral MUST be provided for any patient to be seen at our clinic. You may submit an appointment request before or while waiting for a referral. Should your doctor choose not to provide a referral, you may still submit an appointment request.
Referral Sent:
Name of Doctor/Midwife:
If midwife, which group:
Partner's First Name:
Partner's Last Name:
Home Address
Street:
City:
Province/State:
Postal/Zip:
Phone:
Email:
Description
Is baby latching onto the breast:
Please provide a VERY BRIEF description of your problem:

Note: Please bring whatever form of supplementation you are using, be it expressed breastmilk or formula, we do not provide it.
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Clinic Location

Patient Information

Home Address

Description