Request an Appointment for Your Child with a Specialist

Submit an Appointment Request

Fill out the form or call us at 314-268-4010 to request an appointment with a pediatric specialist.

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

Patient's First Name *

Patient's Last Name *

Birth Date

Please enter as 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 a five-digit ZIP code

Who referred you for this specialist appointment? *

Primary Care Provider

Self-referral

If referred by a provider, please specify provider's name:

Appointment time preference

Select the type of care your child needs: *

If you are unsure about the type of care your child needs, select the closest option and our scheduling team will direct you to the appropriate service.

I have read the Notice of Privacy Practices. *

address1

Schedule with Top Pediatric Specialists

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. 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: call 314-268-4010 to schedule.
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 patient is experiencing a medical emergency, please call 911.