Schedule a Check-up

Please use this form to request a routine physical or sports physical with one of our physicians. If your child is 3 years or older, be sure it has been at least one year since your last check-up. Most insurance companies will only pay for one physical per year after the age of 2 years.

If you are a new patient, please call the office directly for your appointment.

* Required Fields  

*Which doctor would you like to see?

*When would you like your appointment?

*If your primary provider does not have an available appointment within your desired timeframe, would you be willing to see a different physician?

*What day of the week would you like the appointment?

*What time would you prefer your appointment?

Special Instructions:

*Patient name:

*DOB:

*Contact name:

*Call back phone number:

*Contact email address for confirmation:

 



 

Terms Of Use
Terms of Use

Accept    Decline

Terms of Use

If you choose to communicate with Pediatric Associates (PA) via the web, you agree to the following:

  1. Email is not to be used for emergencies or time-sensitive issues.  Email is provided as a convenience to our patients.
  2. Communication is for established patients of PA only.  If it cannot be confirmed by our staff that your child is a patient of our office, your communication will be ignored.
  3. Secure email is not 100% secure.  An unintended recipient may view any information sent via email.  PA will not be held accountable for mishandled email.
  4. PA cannot be responsible for emails not being received due to technical issues with our hosting server.  If you do not receive a response in a timely fashion, you need to call the office.
  5. We reserve the right to copy emails sent to us to be used in the medical record.
  6. If you have questions about these policies, please call the office.

If you do not accept these terms, we will not be able to process your request online.

Please call the office at 816.561.8100 for further assistance.