girl getting routine check up by doctor

Immunizations

  • Pack your child’s favorite toy, book, or comfort item
  • Try relaxation techniques, like deep breathing
  • Stay calm and foster a stress-free environment
  • Tell your child what to expect
  • Reward and praise

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Submit the form and our staff will call you to set up consultation!

Are you a New or Existing Patient?


Preferred Location




First Name
Last Name
Child’s Full Name (if born)
Child’s Date of Birth (if known)
Do you have insurance?


Provide the insurance provider name(s)
Provide your insurance number(s)
Mailing Address
City, State Zip
Primary Phone Number
Your Email
Additional Comments
How did you hear about us?





https://valcourtpediatrics.com/resources/new-patient-checklist/
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