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Healthy Families Feeding and Nutrition Clinic Referral Form

The Healthy Families Feeding and Nutrition Clinic offers one-on-one support to help families make informed feeding or nutrition decisions that are best for their family. A Registered Nurse or Registered Dietitian will provide families with in-person, virtual or phone support.

Client must consent to this referral, please click yes below to indicate client has consented.

For more information or to speak with a Healthy Families team member, call 1-866-888-4577, ext. 5003 or visit us at

Personal information on this form is collected under the authority of the Health Protection and Promotion Act R.S.O. 1990, c.H.7 as amended and Regulated Health Professionals Act S.O. 1991, C. 18, and will be used for assessment, management, treatment, and reporting purposes. Questions about the collection, use and disclosure of this information should be addressed to the: Medical Officer of Health, 200 Rose Glen Road, Port Hope, Ontario, L1A 3V6, or toll-free: 1-866-888-4577.

August 2022

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