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Appointment Disclosures
Michael
2023-05-15T14:49:37-05:00
APPOINTMENT SCHEDULER
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*
" indicates required fields
Is this a medical emergency?
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Yes
No
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?
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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?
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No
Yes
Enter your telephone number for verification.
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Do we have the patient's COMPLETE immunization records?
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Yes
No
Disclosure of ALL Concerns
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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.
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 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
.
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."
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