Dear Community Partner:

Please find attached our most current Monarch clinic referral form. Please note that the breastfeeding mother and baby are assessed together as a dyad for the most comprehensive care. Please fax completed referrals to 613-226-7059.

For Jaundice Assessments:

Referrals are required from Health Care Provider for babies born at The Ottawa Hospital General or Civic Campus’ only are who are less than 7 days of age. Please have the form faxed over and call to receive an appointment date and time and provide the information to the patient. Monarch does not function as a walk-in clinic.

For Tongue Tie Assessments:

Referrals are required in writing from Physicians, Nurse Practitioners, Midwives, and Lactation Consultants. Either the form is faxed over or sent with the patient. If the patient is bringing the form, the health care provider must call to receive an appointment date and time and provide the information to the patient. Monarch does not function as a walk-in clinic.

Infant does not have to be born at The Ottawa Hospital for tongue tie assessment. Infant must be 4 weeks of age or younger for tongue tie assessment.

For Breastfeeding Consults:

It is strongly advised to have seen an IBCLC in the community prior to requesting our services. If it is medically indicated after this, a referral from an MD for both Mom and Infant is required and we are more than pleased to assess the dyad.

If you are an IBCLC in the community, you could fill in most of the referral form and have the patient bring it to their FP visit to further assist in the referral process.

 

Sincerely,
The Monarch Team