Appointment Disclosures

Is this a medical emergency?(Required)

Yes

STOP using this scheduler and dial 911 if you have any emergency such as chest pains, uncontrolled bleeding, poisoning, constant vomiting, serious breathing problems, or anything else you deem as life or limb threatening. Pediatric People's online scheduler is not for emergency treatment.

What best describes the visit you are scheduling?(Required)

Sick or Urgent Care (fever, cough, fracture, headache, burn, laceration, etc.)

Behavioral Care (ADD, ADHD, mental health, etc.)

Annual Well Care

Ear Piercing

Flu Shot

Typhoid Vaccine

Are you a new patient?(Required)

Yes

Are you a new patient?(Required)

Yes

Have you completed the required registration documents?(Required)

Yes

Enter your telephone number for verification.(Required)

Do we have the patient's COMPLETE immunization records?(Required)

Yes

Click here for complete instructions on becoming a new patient. If you have questions, please send a text message to us at 972-382-5796. If you are a new patient and you've completed all the requirements, please change your answer to "No."

Before scheduling this visit, we must have the patient's complete immunization record. If you need more information, please contact us at 214-396-5200 or send a text to 972-382-5796. If you need to request medical records from a previous physician, click here.

The telephone number you entered is invalid. Please enter a phone number that is associated with your child's account. If you are an existing patient and need assistance scheduling this appointment please contact us at 214-396-5200 or send a text message to 972-382-5796.

If you are a new patient, click here for complete instructions on becoming a new patient. If you have questions, please send a text message to us at 972-382-5796

Before scheduling your appointment, please complete registration documents.

Once the documents are completed, you will be automatically directed to our online appointment scheduler.

IMPORTANT: Insurance Coverage Disclaimer for Well Care Visits(Required)

Most insurance plans cover one well care visit per calendar year. By scheduling this appointment, you confirm that you have verified your eligibility and coverage for a well care visit with your insurance provider. If your insurance denies coverage due to frequency limitations or other policy restrictions, you will be responsible for the full cost of the visit, which may exceed $1,000. It is your responsibility to contact your insurance provider PRIOR to scheduling if you are unsure of your coverage.

Disclosure of ALL Concerns(Required)

I understand that the doctor will ONLY discuss the concerns that I've listed (on the next page) when scheduling this appointment. I understand that additional concerns not disclosed will require an additional visit.

This field is hidden when viewing the form

Is Phone Valid - Well

This field is hidden when viewing the form

Is Phone Valid - Urgent

APPOINTMENT SCHEDULER