If you would like to have your child assessed at Nicklaus Children's Hospital, please complete the Global Health Patient Registration Form below.
In order to schedule appointments we first need a fully-completed registration form and all related medical records (including any imaging, laboratory, etc). Once Global Health receives all relevant information, your case will be reviewed by the medical staff. Be advised that routine appointments are generally scheduled for dates 2-4 weeks after your case has been initiated with a coordinator. If this is an urgent medical request requiring an appointment within two weeks, please contact Global Health directly at (305) 662-8281.
Country selector (Billing Address):
To expedite your request, we will need copies of the child’s latest medical records (clinical summary containing history and current status, along with results of any recent tests. You may upload the records here or Fax them to (305) 668-5586.
Preferred dates to visit:
(Please provide a two week range if possible)
Please print and complete the Consent for Release/Request Form
and send it back to Global Health Services along with a copy of a picture ID (such as a Driver's License or Passport). You may fax it directly to 305-668-5586 or email it to email@example.com
If you need to reach the Global Health Department, you may reach them directly at:
Local Phone: (305) 662-8281
Toll-free: (888) 797-6010