Background: AYA cancer survivors are at elevated risk for developing therapy-related adverse health outcomes and require life-long risk-adapted health care. We determined the location and providers of LTFU care received by a population-based cohort of survivors and explored the demographic, disease and treatment factors that predict care received. Methods: We conducted a retrospective study using multiple linked administrative health databases in Ontario, Canada. Five-year AYA cancer survivors were identified from the IMPACT cohort, which consists of all AYA who were 15-20.9 years of age at diagnosis of one of six specified cancers in Ontario between 1992-2010. We defined four models of care: specialized survivor clinic; general oncology clinic; primary care physician; no regular care. Specialized survivor clinic attendance was only available to those treated at a paediatric cancer centre. Separate Poisson regression models determined attendance rates, adjusting for demographic, disease and treatment characteristics. Results: The cohort consisted of 1574 survivors (1066 treated at adult centres; 508 treated at paediatric centres). Median follow-up from five-year survival was 8.7 years (95% CI, 4.3-13.9 years). Over their follow-up, the highest level of care accessed by survivors was: survivor clinic (16.7%), oncology clinic (47.3%), PCP (9.3%), no regular care (26.7%). Among those eligible for the specialized survivor clinics, greater attendance was observed in females, those younger at diagnosis, living closer to a clinic, and those treated with Bone-Marrow Transplant. Specialized clinic attendance decreased by 19% with every 2-years of follow up. In contrast, the risk of receiving no regular care among all survivors was highest in males and increased by 20% with every 2-years of follow-up. Conclusions: Despite the need for risk-based care, most eligible AYA survivors do not attend specialized clinics, and almost one-third receives no regular care, with lack of care increasing over time. Strategies are needed to ensure that the maximum number of survivors receive life-long risk-based care.