New Patient Request for an Appointment


New Patient Request for an Appointment

Online appointment requests are for regular well visits (check-ups) and immunizations only. If your child is sick, please call our office at (212) 874-4500. We cannot respond to requests for sick visits or newborn appointments through this portal.

Online appointment requests will be processed within 48 hours Monday through Friday. If you do not hear from us within that timeframe or should you have any questions regarding this online form, please contact us by phone.

Westside Pediatrics, P.C. will not be held responsible should your electronic message not be transmitted due to technical problems related to this site or the hosting server.

All personal identifying information provided by you is encrypted and your message will not be shared with any third parties.

NOTE: With this form, you are submitting a request for an appointment. You are NOT scheduling an appointment. A representative from Westside Pediatrics will contact you to help you schedule an appointment.

* Required Information

First Name*      Last Name*

Phone Number*      Email Address*

Please indicate how you would like to be contacted:



Have you been seen by Westside Pediatrics P.C. before?



Preferred Day of Week (Select top two preferred days):

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Preferred time:  

*Please list the nature of your problem, question or comment:

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