Patient Information

New Patient Referrals – Needed Information:
Referrals to be made directly to Pediatric Surgery from medical facility:

Full Patient Name
Date of Birth
Social Security Number
Mailing Address &
Phone Number(s)

Contact Family Member’s Name & Relation
Diagnosis & Reason for Consultation
Supporting Documentation (Physician Notes)
Copy of Insurance Card

Once this information has been received and the insurance has been verified, our appointment scheduler will contact the family with an appointment date and time.

Clinic Schedule
Clinic Dates Physicians
Medical Plaza Tuesday Mornings Dr. Kays & Dr. Chen
Medical Plaza Tuesday Afternoons Dr. Kays & Dr. Chen
Medical Plaza Thursday Mornings Dr. Islam
Medical Plaza Thursday Afternoons Dr. Islam and Dr. Beierle
Burn Clinic Thursday Mornings Dr. Beierle

2007-2008 Outreach Clinic Schedule
Daytona Beach Tallahassee (tentative dates)
TBA 10/22/07
  1/28/08
  4/21/08

In most cases, clinic visits may take most of your morning or afternoon. This visit will include an examination of your child and discussions about his & her problem. You and your family may have questions, including your own view of what might be helpful, which is important to us. A responsible family member must accompany all patients younger than 18 years of age for this evaluation. If you have any information from your referring physician, please bring this with you (example: x-ray films, lab studies and/or clinical information).

Also, it is absolutely important for you to bring your insurance card with you to this appointment. If your insurance authorizes this visit & requires a co-payment, you will be asked for that amount at the conclusion of your evaluation. If you are uninsured, please bring proof of income with you & we will have a financial representative counsel you on possible services for children that assist with medical fees in order to reduce the financial burden for the family.

Should you need to cancel or reschedule the appointment, please contact us within 48 hours prior to your appointment. If you have any questions, please contact our office.

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