Request for support

To receive support services from the Pregnancy and Infant Loss Network at Sunnybrook, please fill out our intake form below.

To learn more about the support services we offer, visit our support programs page.

PAIL Network provides support to any family in Ontario who has experienced the loss of their pregnancy or the death of their baby up to 12 months of age, including:

  • First trimester loss / early pregnancy loss
  • Termination of pregnancy / interruption of pregnancy
  • Stillbirth
  • Neonatal death
  • Infant death due to SIDS/SUIDS

Request form

In order for us to provide you with the best possible match for peer support, please provide as much information as you are comfortable sharing. Please note, we are unable to offer support outside of the province of Ontario. The form below can not be submitted if the fields marked with an *asterisk* are incomplete.

* indicates a required field.

Date of birth
Address

Contact information

I grant my consent to be contacted via the methods listed above.
I would like to be contacted about my accessibility needs.

Support type

Preferred method of support is
Contact preference
How did you hear about PAIL?

Please share the details of your loss

Date of loss

Category of loss