Valley Pediatrics

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Call Us: (215) 293 - 6010

Request A Referral

Our Referral Office requires at least two days notice to process your request. Please complete all of the information on this form. Missing information will cause a delay in processing your referral. Also, a reminder that most all referrals are sent electronically to the specialist.

Terms of Use
You are entering a secure area of our website. Valley Pediatrics will not be held responsible in the event your electronic message is not transmitted to us due to technical problems related to our site. All personal identification is encrypted and your message will not be internally or externally forwarded to other third parties. Only Valley Pediatrics will be using your information.

*Required Field

*Agree to Terms:
*Date:
*Patients Name:
*Patients Date of Birth:
*Patients Chart Number:
Patients Social Security No.:
*Home Phone Number:
*Email Address:
*Parents Name:
*Name of Insurance Co.:
*Insurance ID Number:
*Name of Specialist/Facility:
*Speciality:
*Specialists Phone Number:
Specialists Fax Number:
*Reason for visit or test:
*Appointment Date:
*Name of test or procedure:
*Date of test or procedure:
*Requesting Doctor:
Questions or comments:




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Office Hours

Valley Pediatrics, P.C.
866 W. Bristol Road
Warminster, PA 18974


Mon - Wed 9:00 AM to 7:00 PM

Thursday 9:00 AM to 6:00PM

Friday 9:00 AM to 5:00PM

Saturday 9:00 AM to 1:00PM

More details and phone numbers

Prescription Refills

Please allow two days to complete a prescription refill request to be called into your pharmacy. Controlled substance prescriptions must be picked up during office hours.

Request a prescription refill