Boy Playing

Well Visit Request Form

We are happy to announce the initiation of online appointment scheduling for well child/baby appointments and medication follow-ups. Please take a quick look at the doctors’ availability and fill out the brief survey. A member of our staff will get back to you within 24-48 hours. If you have not heard back within that time frame, please feel free to call.

Please note: This form is for the sole purpose of requesting a Well Visit appointment for our established patients only; all other appointments must be scheduled by calling our office.

If you are not a patient of Village Pediatrics but wish to join, please click here.


The typical physicians’ schedules are as follows:

Dr. Nikki
Monday: generally ouf of the office
Tuesday: 9:40am to 1:15pm
Wednesday: 9:40am to 4:15pm
Thursday: 9:40am to 11:15am
Friday: 9:40am to 4:15pm

Dr. Jenn
Monday: 9:40am to 11:15am
Tuesday: 9:40am to 4:15pm
Wednesday: 9:40am to 1:15pm
Thursday: 9:40am to 4:15pm
Friday: generally out of the office

Dr. Robin
Monday: 9:40am to 4:15pm
Friday: 9:40am to 11:15pm

Please complete the following request form:


Is your child on medication?:


 Security code

Thank you.