The Neuromodulation Bowel and Urologic Alliance (NEBULA) Program wants to ensure that your child gets the best and most appropriate medical care possible. To determine the appropriateness of evaluation in our program, we require the following information be sent to us.   

1. If you are interested in our program and are followed by any CHOP providers, please discuss if these providers can refer you to the NEBULA Program by ordering “Consult to the NEBULA Program” within our electronic medical record system.
2. If you are not followed by any CHOP providers, and are interested in our program, please download our intake form, fill it out and save a copy to your computer. Email the completed form to NEBULA@chop.edu.
3. Our team requires all past medical records if care has been provided at institutions other than CHOP. This includes specialists’ clinic visit letters, operative/procedure records, imaging with associated reports and laboratory tests.
4. Please sign our CHOP electronic medical record form (Obtaining Medical Records | CHOP), available in English and Spanish, with a year-long date and return to NEBULA@chop.edu in the event we have to obtain additional records.     

Please note that we will not be able to discuss scheduling any appointments until we receive all the information above and review patient candidacy with our team.