request an appointment

follow up appointments, video visits and second opinions

If your child is an existing patient, log in to MyKidsChart to schedule directly with your provider for follow up care. If you don't have an active MyKidsChart account sign up today or fill out the request for an appointment form below.

For video visits or second opinions please complete the form below to request an appointment with one of our specialists or call us at 937-641-4000.

Note for Tricare insured patients: A referral from your physician is required in addition to completing the form.

service/clinic

visit type

patient information

patient's first name

patient's last name

gender

patient's date of birth

parent/guardian's first name

parent/guardian's last name

phone number

best time to contact ( 8:00 am to 8:00 pm)

street address

state

zip code

reason for visit request (please briefly explain the chief complaint)

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Vaccines are now available at Dayton Children's to help protect you and your family this flu season.

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