We provide outpatient care at all Shriners Children's locations and inpatient admissions at select locations, based on a child's medical needs.
Please use the form below to submit information that will help our intake team select the most appropriate Shriners Children’s location for your child’s medical needs. Please DO NOT submit multiple appointment request forms. Our system only recognizes one form per patient. Our intake team will review the information and reach out via email and phone as soon as possible. Thank you.
IMPORTANT NOTICE: If your child requires emergency care, please call 911. If you need urgent care for your child, please call us at 1-800-237-5055 rather than submitting the request form.
Physicians and healthcare providers can request appointments, start transfers or contact us with questions.