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International Patient Program
International Patient Program

International Patient Referral Form

All families of international patients requesting treatment for their child at SickKids are required to complete a referral form. The form must be completed in English. There are two sections that need to be completed within the application, as follows:

  1. Pages 1 to 3 must be completed and signed by the child's parents or legal guardian
  2. Pages 4 to 5 must be completed by the child's doctor, and must include:
    • A complete medical history,
    • Current medical notes (completed within the last six months),
    • Copies of the child's recent laboratory and other test results, including imaging CDs,
    • A copy of the moving echocardiogram (ECHO) for review, if your child has a heart condition requiring possible treatment at SickKids

Please send your completed referral form to the International Patient Program by:

  • Email: international.patientprogram@sickkids.ca
    Please note that email may be intercepted between the sender and the receiver and is therefore neither secure nor confidential. Your continued use of email communication confirms that you accept this risk.
  • Fax: +1-416-813-8667
  • Mail/Courier: International Patient Program
    The Hospital for Sick Children
    555 University Avenue
    Toronto, Ontario, Canada
    M5G 1X8