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Please note that our intake forms are currently being revised. To request an evaluation, you can click on the Request an Appointment feature on the main page or contact our office directly at 617-355-4683.

Important forms:



 Under 27 Months


 Ages 28 Months-5 Years


 Ages 5 Years and Up





If two weeks after you have submitted the intake forms and questionnaires you have not received notification that the DMC has received them please call (617) 355-4683 and let us know.

Completed forms can be mailed to:

Boston Children's Hospital
ATTN: Intake Coordinator
300 Longwood Avenue
Fegan 10
Boston, MA 02215


Request an Appointment

If this is a medical emergency, please dial 9-1-1. This form should not be used in an emergency.

Patient Information
Date of Birth:
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Appointment Details
Send RequestIf you do not see the specialty you are looking for, please call us at: 617-355-6000.International visitors should call International Health Services at +1-617-355-5209.
Please complete all required fieldsThis department is currently not accepting appointment requests onlineThis department is currently not accepting appointment requests online

Thank you.

Your request has been successfully submitted

You will be contacted within 1 business day.

If you have questions or would like more information, please call:

617-355-6000 +1-617-355-6000
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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO