Patient Chart Request

If your child is our patient and your require a copy of his/her chart, please fill out the form below to request a copy.

Please Note. There will be a charge for this service*

Patient Information

Please enter your child/patient's information below [as it appears on Health Card (HCN)] and double-check to make sure the information is correct.

If there are more than 5 patients, please fill out the form a second time.

*This is an uninsured service, not covered by OHIP. We will contact you first with an estimate of the cost. Once you agree to the cost, we will prepare the chart for you and contact you with an appointment to collect the chart. Payment must be received before chart can be released to you. Charges are based on OMA rates of professional review of the chart and charges for the copies, based on the number of pages. Please do not come to the office without an appointment. By pressing 'Submit' below, you agree to read the above and follow these instructions.