Kidcrew Booking Form Ideal for scheduling ahead. Please expect a 2 to 3-day response time. If you need to book sooner click here. Returning Patient(s)Please confirm your child is an existing Kidcrew patient:* Yes, my child is a returning patient. No, this is our first visit. *Important: We are accepting new primary care patients at this time. Click this link to book your child's first visit with Kidcrew! We ARE accepting In-Person sick visits for new patients. Click this link to book your child's first visit with Kidcrew! We ARE accepting Sub-Specialty Care patients with a referral from your physician, nurse practitioner, or midwife. We ARE accepting Allied Health Care patients. Click this link to book your child's first visit with Kidcrew! Thank you, Team KidcrewYour Contact Info (parent).Parent's Name* First Name Last Name Email*We will use this email to confirm your appointment. Phone*Please confirm your phone number.Your Child's InfoHow Many Children Are You Bringing for Assessment?* One Child Two Children Three Children Four Children I'm Bringing One ChildChild's Name* First name Last Name Is this child a Kidcrew patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Developmental Pediatrics Dietician Endocrinology Gastroenterology Hematology Lactation Massage Therapy Naturopathy Nephrology Neurology Occupational Therapy Osteopathy Otolaryngology Parent Consulting Physiotherapy Psychiatry Psychology Respirology Rheumatology Sleep Social Speech Sports Medicine Travel Medicine Other Reason For Visit, or Other Details*Please provide the reason for your visit.Please Double-Check All Info Above (spelling, etc.)* YES, I Double Checked Please double check all your info, this saves time and will speed up the confirmation process.I'm Bringing Two ChildrenChild (1)* First name Last Name Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 1 Reason For Visit, or Other Details*Child (2)* First name Last Name Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 2 Reason For Visit, or Other Details*Please Double-Check All Info Above (spelling, etc.)* YES, I Double Checked Please double check all your info, this saves time and will speed up the confirmation process.I'm Bringing Three ChildrenChild (1)* First name Last Name Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 1 Reason For Visit, or Other Details*Child (2)* First name Last Name Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 2 Reason For Visit, or Other Details*Child (3)* First Last Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 3 Reason For Visit, or Other Details*Please Double-Check All Info Above (spelling, etc.)* YES, I Double Checked Please double check all your info, this saves time and will speed up the confirmation process.I'm Bringing Four ChildrenChild (1)* First Last Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 1 Reason For Visit, or Other Details*Child (2)* First Last Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 2 Reason For Visit, or Other Details*Child (3)* First Last Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 3 Reason For Visit, or Other Details*Child (4)* First Last Kidcrew Patient?* Existing Patient New Patient Name of physician or specialist you are requesting to see?* This visit is for?*Please choose all that apply General Pediatrics Allergy Cardiology Chiropody Chiropractic Dermatology Dietician Endocrinology Gastroenterology Hematology Travel Medicine Lactation Massage Therapy Naturopathy Neurology Occupational Therapy Osteopathy Otolaryngology Physiotherapy Psychiatry Psychology Respirology Sleep Social Speech Sports Medicine Other (Required) Child 4 Reason For Visit, or Other Details*Please Double-Check All Info Above (spelling, etc.)* YES, I Double Checked Please double check all your info, this saves time and will speed up the confirmation process.Your Requested DatePreferred Date (this is a request only)* DD slash MM slash YYYY This is a requested date only, we will confirm by email.Time* : Hours Minutes AM PM AM/PM This is your requested time, we will confirm with you by email or phone.This is a booking request only. We will email a confirmation.* Yes, I Understand. This form is not a confirmed booking - we will email you a confirmation.Confirm Your RequestIMPORTANT: Please wait for the confirmation message before closing this window.CAPTCHA
