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Online Remote Consultation Intake Form

Online Remote Consultation Intake Form

Please fill out the form below to learn if your child is eligible for an online written consultation from a specialist at Children’s Hospital of Philadelphia. A member of our National Patient Services (NPS) team will reach out to you to learn more and determine next steps. 

NOTE: The Remote Online Consultation Program is NOT available to patients living within CHOP’s primary service area. This includes Berks, Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery, Northampton and Philadelphia counties, in Pennsylvania; Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Hunterdon, Mercer, Middlesex, Monmouth, Ocean, Salem and Somerset counties in New Jersey; and New Castle County, Delaware

If you have any questions about the process or wish to speak to someone from our team about scheduling an in-person appointment at CHOP, please call us at 267-425-3560 Monday-Friday 8 a.m.-5 p.m. EST or email chopusa@chop.edu

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