After you fill out the form below, please submit the following information by email to AADPrecords@chop.edu or fax 215-590-3198.
- Download our New Patient Intake Form here. When it is completed, send it to AADPrecords@chop.edu. After you fill out the form, please remember to save a copy to your computer and to submit your personalized version.
- A medical summary or clinical summary from the referring primary care provider or specialist. If the referring provider is at CHOP, you do not need to provide this summary.
- A copy of the front and back of your insurance card (if new patient to CHOP).
- Medical records from outside institutions, including medical tests radiology reports and laboratory reports that pertain to the reason for your child’s visit can be faxed to 215-590-3198 or emailed to AADPrecords@chop.edu.
- Please fill out our AADP HIPAA form and send it to AADPrecords@chop.edu.
Please note that we will not be able to discuss scheduling any appointments until we receive all the information above.