Breastfeeding companion program request form

Fields marked with a * are required.

Please use this form to request a breastfeeding companion.

Our goal is to contact you within 2 business days. You can also call us during normal business hours at 705.522.9200, ext. 427 (toll-free at 1.866.522.9200).

To have a trained volunteer mentor you over the phone, please provide the following information.

Your privacy

Personal information contained on this form is collected under the authority of one or more of the following (as amended): the Health Protection and Promotion Act, R.S.O. 1990; the Immunization of School Pupils Act, R.S.O.1990; the Regulated Health Professions Act, 1991, S.O. 1991; and is in compliance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990 and the Personal Health Information Protection Act, 2004, S.O. 2004. This information is used to ensure that all appropriate personal care and public health services are provided, and that necessary statistics are kept. Questions about this collection should be directed to the Privacy Officer at the Sudbury & District Health Unit, 1300 Paris Street, Sudbury, ON P3E 3A3, 705.522.9200.

This item was last modified on June 12, 2015