Are We a Good Fit?

Is Summer Pediatrics a Good Fit for Your Family?
At Summer Pediatrics, we’re committed to providing exceptional care and a positive experience for every child and family. Take our quick three-question quiz to see if we’re the right fit for your family.
Patient Details
Patient Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Relationship*
Patient Insurance
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Vaccinations
When it comes to vaccinations for my child, I prefer the following approach:*

I trust my pediatrician’s expertise and want my child to receive all recommended vaccines on schedule, including HPV and influenza.I only want my child to receive the vaccines required for school attendance.I’m not opposed to vaccines, but I prefer to have them spaced out over time.I do not believe in vaccinating my child and do not plan to give them any vaccines.
Wellness Visits
My preferences for wellness check-ups are:*

My pediatrician should recommend a wellness visit at least once a year, and more often for infants and young children.I only want to schedule wellness visits when shots are due or when required by school or camp.I prefer to come in only when my child is sick.I do not want to schedule wellness visits.
Acute (Sick) Visits
When my child is sick, I typically:*

Call my pediatrician for advice or an appointment, even after hours.Prefer to see my pediatrician, if possible, but will go to urgent care if it’s more convenient.Go directly to the nearest urgent care or emergency department without contacting my pediatrician.Call my insurance provider’s telehealth service to get a prescription over the phone.
Score
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Is Summer Pediatrics a Good Fit for Your Family?

Patient Details

Vaccinations

Wellness Visits

Acute (Sick) Visits