(MWPH Patient Families ONLY) Car Seat Installation Appointment Scheduling

(MWPH Patient Families ONLY) Car Seat Installation Appointment Scheduling

Community Benefits Program at Mt. Washington Pediatric Hospital
Mt. Washington Pediatric Hospital is committed to providing exceptional programs and services to our patients, families, and community. Our Car Seat Installation & Injury Prevention Program is one of those programs.

To better serve you, please complete the MWPH Car Seat Installation Appointment Scheduling form to the best of your ability. By doing so, you are helping us to better prepare for a successful car seat installation and education.

Additionally, please alot 45 min to an hour of your time for each car seat installation.

** If you have more than one child, please complete a form for each child that is needing a car seat installation.
Caregivers Information*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Personal Email (We will email you an appointment reminder)*
example@example.com

YesNo
What type of car seat do you have? (Please include the Car Seat Manufacturer and Model Name, ie. Graco Snugride 35 LX)*
What type of vehicle do you have? (Please include the Vehicle Make, Model and Year, ie. 2019 Ford Focus).
Child's Age in Years (If your child is less than 1 years of age, please list their age in months). *

Appointment*
Appointment
*If you are in need of an appointment time or day that is not available on the calendar, please contact our MWPH Car Seat Hotline at 410-578-8600 for additional assistance with scheduling.