Primary Care Transfer Request Simple steps to keep your child’s care moving forward. Primary Care Transfer RequestYou’ve selected the following pediatrician:Please confirm your child is currently a Primary Care patient at Kidcrew:* Yes, we are currently registered with a Primary Care Pediatrician at Kidcrew. No, my child is not currently a Primary Care patient at Kidcrew. Your Child's Current Primary Care PediatricianPlease enter the name of your current pediatrician at Kidcrew.How would you like to continue your child’s primary care? Permanently transfer primary care to this pediatrician Temporarily receive care from this pediatrician Please confirm > PermanentYou are requesting to permanently transfer your child’s primary care to the pediatrician you selected. Yes, I confirm, I'm requesting a permanent transfer Please confirm > TemporaryYou are requesting temporary care with the pediatrician you selected. Your child’s primary care pediatrician will remain unchanged. Yes, I confirm, I'm requesting a temporary transfer *Important: This form is for transferring current Kidcrew patients to a new padiatrician within the clinic. Kidcrew is accepting new primary care patients - click here to register your child with a Kidcrew Primary Care Pediatrician.! Thank you, Team Kidcrew Your Contact InfoParent's Name* First Name Last Name Parent/guardian email address on file*This should match the email in your child’s Kidcrew patient profile. Your Child's InfoChild's Name* First name Last Name Child’s Date of Birth:*Health Card Number and Version Code*Helps us prepare, but you can leave this blank if needed.(Optional) Additional NotesAnything else you'd like us to know?Confirm Your RequestPlease Double-Check All Info Above (spelling, etc.)*Please double check all your info, this saves time and will speed up the registration process. YES, I Double Checked IMPORTANT: Please wait for the confirmation message before closing this window.CAPTCHA
