Primary care appointment request form

Pediatricians from Children’s Hospital of Wisconsin provide primary care at more than 20 offices that are conveniently located throughout southeast Wisconsin. If you would like to request an appointment with a pediatrician, fill out the form below and we will contact you within 1-2 business days to set up your appointment. If you are a MyChart user, you may schedule an appointment online.

Note: Do not use this form for urgent or emergency situations. Please call your doctor's office right away, or if this is an emergency, please visit your nearest emergency room. Learn more about Children's Hospital of Wisconsin's ER.

Your information
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What is the reason for your visit?


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Clinic and provider information
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How did you hear about us?