Patient Request for Pediatric Specialist Appointment

Are you a provider? Refer a patient to a pediatric specialist using the physician request form.

It's easy for you to request an appointment with a pediatric specialist at SSM Health Cardinal Glennon Children's Hospital using our online pediatric appointment request form or call us at 314-268-4010. After submitting the request form, an SSM Health Cardinal Glennon representative will call you to schedule your child's appointment within three business days.

When a referral is received, most departments will reach out to families within 48 hours to schedule. Exceptions include:

Allergy & Dermatology: To schedule an appointment, call 314-268-4010
Developmental Pediatrics: Online referrals only; patients and referring offices will be notified once the patient has been added to wait list. For more information, visit the Knights of Columbus Developmental Center

If your child is experiencing a medical emergencies, please dial 911.

Request an Appointment with a Specialist

Patient's First Name *

Patient's Last Name *

Birth Date

Please enter patient's birthdate in MM/DD/YYYY

Parent or Guardian's First Name (if patient is under 18) *

Parent or Guardian's Last Name (if patient is under 18) *

Email Address

Parent or Guardian's Phone Number *

Please enter phone number as XXX-XXX-XXXX

Best time of day to reach me

Address *

Address 2

City *

State *

ZIP *

Please enter phone number as XXX-XXX-XXXX

Appointment time preference

Select the type of care your child needs: *

I have read the Notice of Privacy Practices. *

address1

Patient Request for Pediatric Specialist Appointment

Request an Appointment with a Specialist

Select Location