Putnam Valley Pediatrics

 

Request a Preventive Care Appointment


This page is to be used to request future preventive care appointments ("checkups") only.

Since we prefer to see children with illnesses or injuries on a same-day basis, please call the office directly for these types of appointments.  (845) 528-5222. 

We check requests each weekday, Monday through Friday, and will contact you to confirm appointment dates and times. 

Please be aware that we will try to accommodate your date and time requests if possible, but ask that you give us at least two weeks advance notice.

The afternoon/after-school time slots are usually pre-booked at least a month in advance since these are premium times for most parents.

Please enter all the requested information below. Once completed, please mouse-click on the "Submit" button below to send your request.  If you have more than one request (two or more children), after you submit your first request, mouse-click the "Clear Form" button, enter your next requests, and submit each one.

 

Please be sure to enter either a telephone number or an email address (or both, if you choose) so we can send you the information about your child's appointment.

 

 

1. Your child's name (First, Last): 

 

2. Your child's date-of-birth (mm/dd/yy):

 

3. Range of dates for appointment:  From   To

 

4. Preferred weekday:

 

5. Preferred times:

 

6. Person requesting appointment (Name):

 

7. Daytime phone number including area code: 

 

                                                   Extension, if any: 

 

8. E-Mail address for confirmation: 

 

 

 

      

 

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