• Appointment Request Form

  • Please arrange for your referring doctor to FAX copies of your childs medical records to our office, including growth charts, all laboratory and x-ray reports related to current GI problem, and any other pertinent information prior to your appointment. Our fax number is 866-447-2930

    No Doctor-Patient relationship exists until your child is seen in consultation by a provider in our office.

  • *Due to HIPAA regulations, please do not include any medical information that is beyond what is necessary for treatment and appointment request. You are authorizing the sharing of medical information between you and this medical office when you are requesting an appointment with our office. 

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