Appointment Request

Making an appointment is easy with our online Appointment Request Form. Fill out the form, submit, and one of our schedulers will respond back promptly with a confirmed appointment time for your child.


All requests submitted online using our appointment request form will receive a response within 1-3 business days, Monday to Friday 9:00 am to 5:00 pm, except on weekends and holidays. Requests submitted on weekends and holidays may take longer please allow ample time or email us directly:
The Appointment Request Form is for existing patients only. For New Patients, please call our office directly to schedule an appointment.


    Patient Name *

    Date of Birth *

    We accept newborns to 18 yrs old.

    Phone Number*

    Preferred format: (123) 456-7890

    Parent / Guardian Name *

    Relationship to patient *

    What is your relationship to the patient for whom you are requesting an appointment for?

    Email *

    Merchant Pediatrics will be responding to this email, please use a password protected account to ensure your privacy.

    Location *

    Select the location most convenient to your needs.

    Requested Pediatrician *

    Please select the pediatrician that is listed on your child(ren) insurance card(s)or call the insurance company to find out who is the PCP assigned. Thank you.

    Reason for Appointment *

    This form is intended for well visits, immunizations and non-sick visits.

    Latest News & Announcements

    • is Here!
    Welcome to the Merchant Pediatrics website! We have designed our site to provide an easier and better user experience...
    • Online Appointments
    Making appointments for your child has never been easier with our new Online Appointment Request Form. Simply click on the Appointments section...