Request an Appointment

NOTE: If your child is experiencing a life-threatening emergency, call 911 immediately. If your child needs immediate care, go to your local urgent care center or emergency department. Find a Phoenix Children's Urgent Care Center near you.

This form is not to be used in situations where care is needed sooner than three business days.

Patient Information
(If none, enter "none")
Parent/Guardian Contact Information
Appointment Information
  • Morning
  • Afternoon

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