WE ARE TRANSITIONING TO A NEW ELECTRONIC HEALTH RECORD IN LATE SEPTEMBER. PLEASE PARDON OUR DELAYS IN RESPONDING TO SOME MESSAGES. THANK YOU FOR YOUR UNDERSTANDING. FLU SHOTS AND COVID19 SHOTS AVAILABLE NOW. CALL FOR APPOINTMENT! If you haven’t been to our office since late October, 2020, please note our new address! You’ll love our new space!

Request Appointment

WE ARE NOT CURRENTLY USING THIS FOR APPT REQUESTS. PLEASE USE OUR NEW PATIENT PORTAL (CALL FOR INFO IF YOU DON'T HAVE A LOG IN YET). WE ARE NOT ACCEPTING NEW PATIENTS CURRENTLY, OTHER THAN NEWBORNS.

Click here for insurance information

Subject

Parent/Guardian Name *

Phone Number *

Email Address *

Child's Name *

Child's Date of Birth *

Is this your first visit with us? *

Type of Insurance *

Reason for Visit *

Preferred Date(s)

Day(s) of preference

Monday Tuesday Wednesday Thursday Friday

Time of Day you'd prefer

Morning Mid-day Afternoon

General Comments

Note: please be sure to request that your medical records be sent to Kids First Pediatrics of Stafford before your first appointment.