Breastfeeding Referral Form

Need Breastfeeding Support?

Fill out the online breastfeeding referral form and a public health nurse will contact you as soon as possible during regular business hours.
Please Note: The Personal Information on this SWPH Breastfeeding Referral Form is collected under the authority of the Health Protection and Promotion Act applicable privacy legislation. This information will be used for delivery of public health programs and services, to assess the need for breastfeeding support, and may be used for evaluation or statistical/research purposes. Any questions about the collection of this information should be directed to:
      SWPH Privacy Officer
      Southwestern Public Health, 1230 Talbot Street, St. Thomas, ON N5P 1G9
      Phone: 1-800-922-0096
Please Enter the Breastfeeding Referral Information Below
Please provide Street Number, Street, City, and Postal Code
This email will be used to send you a response.