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Well Visit Request Form

Online appointment scheduling is available for well child/baby appointments and medication follow-ups. Please take a quick look at the doctors’ availability and either send the office a portal message or 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: 8:30-2:30
Tuesday: 1:30-7
Wednesday: 8:30-5
Thursday: 8:30-5
Friday: generally out of office

Dr. Jenn
Monday: 1:30-7
Tuesday: 8:30-2:30
Wednesday: 8:30-5
Thursday: 8:30-5
Friday: generally out of the office

Dr. Robin
Tuesday: 8:30-5
Friday: 8:30-5

Dr. Sarah
Monday: 8:30-5
Wednesday: 1:30-5
Friday: 8:30-5

Please complete the following request form:


Is your child on medication?:


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Thank you.