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Request an Appointment

Please read the following options carefully before requesting an appointment at Children’s Specialized Hospital.

If you are scheduling an appointment for psychiatry, outpatient counseling, group counseling/social skills group, psychological testing, or educational testing please click here

If you are scheduling an appointment for all other outpatient services, please click here.

 

Child’s First Name*:  
Child’s Middle:  
Child’s Last Name*:  
Parent/Guardian's First Name*:  
Parent/Guardian's Last Name*:  
DOB*:  
Insurance:  
Ins ID:  
Service*:  
Preferred Phone number*:  
Email:  
Preferred time*:  
Best time to call*:   - -
Preferred Site*:  
 
 

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