Children's Hospital Group Visit Request

Online Visit Request Form

Please read the Children's Hospital Group Visit Guidelines before submitting your request below at least 14 days in advance of your desired visit. All requests will be reviewed by the child life department and either approved or denied. Thank you! Name of Group/Individual  *City / State / Zip  *Contact Person  *Day Phone Number:  *Email Address:  *Purpose of visit:  *Number of Group Members/Individual (5 or less)  *Proposed Date of Visit/Activity  *Do you prefer morning or afternoon for your visit?  *As a representative listed above, I have read the requirements for group/individual visits and affirm my groups’/individual willingness to adhere to these guidelines. 
 

Patient Privacy Practices |   Disclaimer |   © 2018 Erlanger Health System. All rights reserved.