Request An Appointment

OU Children's Physicians has over 150 specialists committed to the care of children. The majority of OU Children's Physicians are board-certified in children's specialties. Many provide pediatric-specific services unavailable elsewhere in the state.  405-271-2222 to call for an appointment. or To request an appointment online, please complete and submit the information below. A representative will contact you about confirming your appointment.
* Indicates required information
Patient Information
First Name *
Last Name *
Date of Birth *
Gender *	Male Female
Street Address
City
State	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY
Zip
Guardian Information
Guardian's Name *
Relationship to Child	Mother Father Grandmother Grandfather Foster Parent Sibling (Brother/Sister)Other If Other, please specify:
Appointment Information
Reason for Visit *
Please select preferred Appointment Date *	(mm/dd/yyyy)
Please specify preferred Appointment Time
Please select a 2nd preferred appointment date	(mm/dd/yyyy)
Please select a 3rd preferred appointment date	(mm/dd/yyyy)
Is child a new patient? *	No Yes
If child was referred to us, please enter Physician's Name
Contact Information
Phone Number *
This form is NOT to be used in the event of an emergency!  In the event of an emergency please contact 911. We will work hard to accomodate all requests, but a specific time/date is not guaranteed. Please give us 24 - 48 hours to respond to your request.