● Contact Us

This is the Children's Clinic Contact Us form that you may submit electronically.

 

Please let us know how we may help you.

All information provided will remain confidential.

 

►Please Note:

  • ANY SUBJECT RELATED TO PATIENT CARE must only be discussed in-person or on the phone with our staff and doctors by calling

          (610) 376-8691.

 

  • WE WILL NOT RESPOND to any e-mail if it pertains to PATIENT CARE!

                          

  • DO NOT use this non-secure online form for any comments or questions about patient care.

  • DO NOT include on this non-secure online form any private information such as health insurance policy numbers, social security numbers, etc., that need to be protected by you.

  • ANY SUBJECT RELATED TO PATIENT CARE must only be discussed         in-person or on the phone with our staff and doctors.

*Name:                   

*Phone - including Area Code:                   

*e-mail:

 

Street Address:

City:

State:       Zip:

*Comments:

 

NOTE: If you have not provided information for any item with a red asterisk *, our system will request that you do so before it allows the form to be submitted.

* We apologize for this final required step. So this form will be submitted to us in a way that blocks spammers' Web spiders that automatically read Web pages and then automatically submit automatic bogus forms, you must correctly convert the following number expressed in word form into a  three-digit number:

                                               →  one hundred forty-four

 

Next, ENTER that three-digit number here:     

Thanks for your input! We will respond as soon as possible.

 

Now click the Submit button ONLY ONCE. It may take 30 seconds or more for processing - Thanks again.