Nemours Children’s Clinic, Egg Harbor Township Patient Appointment Form |
Nemours Children’s Clinic, Egg Harbor Township Patient Appointment Form OFFICE HOURS: MONDAY-FRIDAY, 8:30 A.M. – 5:00 P.M. 2500 English Creek Road | Building 1000, Suite 1001 | Egg Harbor Township, NJ | 08234 Pediatric specialists listed below are available at Nemours Children’s Clinic, Egg Harbor Township, NJ. Appointment availability varies by specialist. All of Nemours /Alfred I. duPont Hospital for Children specialists are available in Wilmington, DE. Patient: ____________________________________________________________________________________ Reason for Referral: (diagnosis code/comment)________________________________________________________________ Referring Physician:_______________________________Physician’s Phone Number:___________________________ To schedule an appointment for your child with Nemours Children’s Clinic, Egg Harbor Township call 609-641-3700 Date:__________ Time: __________Specialist Name: __________________________________________________ Allergy & Immunology Stephen J. McGeady, MD Nephrology Bruce Kaiser, MD Cardiology Samuel Gidding, MD Stephen Ritz, MD Takeshi Tsuda, MD Orthopedics Candice Holden, MD Katharine Carter, PA Hematology Gregory C. Griffin, MD Robin Miller, MD Rehabilitation Rochelle Haas, MD Surgery Michael B. Marchildon, MD Dorothy Gould, APN Other Specialists _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Please arrive 15 minutes prior to your appointment to allow for registration. You are asked to bring any pertinent data such as medical records or X-ray films that may be helpful. Insurance information such as claim forms, insurance cards, co-pays, HMO referral forms, etc., must be presented at the time of registration. Driving Directions to Nemours Children’s Clinic, Egg Harbor Township From Philadelphia and West: East on Atlantic City Expressway to Exit 9. Right onto Delilah Rd; left onto English Creek Rd. AtlantiCare Health Park is .25 (1/4) mile on the left. Nemours Children’s Clinic is in Building 1000, Suite 1001. From Atlantic City and East: West on Atlantic City Expressway to Exit 9. Left onto Delilah Rd; left onto English Creek Rd. AtlantiCare Health Park is .25 (1/4) mile on the left. Nemours Children’s Clinic is in Building 1000, Suite 1001. Nemours From the North: South on the Garden State Parkway to Atlantic City Expressway West to Exit 9. Left onto Delilah Rd. Left onto English Creek Rd. AtlantiCare AtlantiCare Health Park is .25 (1/4) mile on the left. Nemours Children’s Clinic is in Building 1000, Suite 1001. From the South: North on the Garden State Parkway to Exit 36 to Black Horse Pike to English Creek Rd. (WAWA on the right). Turn right onto English Creek Rd. Main entrance is .25 (1/4) mile on the right. Nemours Children’s Clinic is in Building 1000, Suite 1001. For more information: Nemours/Alfred I. duPont Hospital for Children, main number: 302-651-4000 Nemours/Alfred I. duPont Hospital for Children, admissions: 302-651-4199 Nemours.org Trouble finding us? Call 609-641-3700 5/10 Write down any questions you have about your child’s diagnosis. Items printed below may help you think of what you want to discuss during your visit with our Nemours team. My current concerns are: What is the next step in treating my child? New medications for my child: What else can I do at home to help my child? My child has experienced these new symptoms: Are there any activities or foods my child should avoid? Are there other symptoms that I should be looking for? Ask the name of the diagnosis/condition. Learn more at Nemours’ www.kidshealth.org. Information on our award-winning site is reviewed by our Nemours physicians specifically for parents, teens and kids. Please write down any additional questions you have for our Nemours team during your child’s visit. _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Advanced pediatric specialty care, here in your community. ©2010. 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