• Appointment Request Form

  • Use this form to request an appointment for preventive (well visit) care, management of a chronic condition or both. You can request an appointments for one or more child on one or two days/times.

     

    If you have NOT already requested Medical Records Transfer, please click here and complete that form first.

    If you have an urgent need for information or to see or speak with a doctor:  Call orText (503) 400-3852.

    Please do not use this form for an appointment for injury or illness.  

    If there is a medical emergency, call 911

  • Appointment Information

  • Preventive or "well visits" are recommended by the American Academy of Pediatrics as follows:

    • Infant well visits:  3-14 days after birth, and at 1, 2, 4, 6, and 9 months of age
    • Toddler well visits:  at 12, 15, 18 and 24 months of age, and as needed at 30 months of age
    • Ages 3 and up - once every year.

    Effective management of chronic conditions in childhood typically involves 2-4 visits per year.  In some cases we can combine preventive care and chronic care visits.  Telemedicine visits can often be used for chronic condition management.

    Help us to allocate the correct amount of time for your child or children by providing information on who needs to be seen and what we need to cover.

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  • Appointment Needs and Preferences

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  • To help us confirm insurance information and check your child/children's eligibility,  you may upload a photo, document or PDF of the front and back of the insurance card or cards.  Drag and drop the file in the box below.

    If you have recently updated your account information with Small Town Pediatrics, you may skip this step.

  • Add Insurance Card Images or Documents
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  • Thank you for making your appointment request on-line.  Our team will get back with you as soon as possible with some options for your family's care.

     

    OPTIONAL:  As we explore the best ways to serve you, we'd welcome any feed-back you can provide on this form and this process.

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