Child and Family Health Referral Form

  • Introduction
  • Information
  • Complete

Thank you for referring your client to York Region Public Health.

Forms submitted after hours or on weekends will be reviewed the next business day.

Please Note
  1. To process this referral for your client, please complete the form by clicking next below
  2. Once the referral is received and processed, York Region Public Health will attempt to contact your client within 1-2 business days
  3. We will reach out to them, to provide support and services, with a text and telephone contact. If unsuccessful in reaching them, we will attempt to leave a voicemail

Please inform the client ahead of time that contact from York Region may appear as a 1-800/blocked/private number, and we recommend checking recent texts and voicemail. You may also encourage them to contact us at york.ca/NurseChat to initiate services or to follow up on the status of this referral.

Upon successful contact, the Public Health Nurse will further assess and connect your client to appropriate programs and services, with their consent.

Privacy Statement 

The Information requested is collected under the authority of the Health Protection and Promotion Act and in accordance with the Municipal Freedom of Information and Protection of Privacy Act. The information will be used as part of our referral process and for accessing Child and Family Health Division's programs and services. For any questions or concerns regarding the collection and use of this information, please contact Health Connection at 1-800-361-5653 ext. 2 or email [email protected]