Welcome to ESD Interactive
Please Note
These forms are offered as a convenience to our patients. As with any piece of communication that comes through our office, requests that come to us via this form are subject to the same privacy policies. However, information sent via this form may not be considered secure. If you have concerns about the privacy of any piece of information required on this page, please call our office instead.
ESD Pediatric Group is committed to providing as many ways to interact with our practice as possible. ESD Interactive is a way for your family to make common, non-urgent requests at your convenience.
The form below will allow our current patients to
- Request a non-urgent office visit such as a checkup or routine follow-up
- Request a prescription refill
- Ask the doctor a question
- Ask a billing question
In order to make a request, select the type of request or question you have from the "I want to" pulldown at the top of the form. This will allow you to fill out the appropriate fields.
The information submitted from this form will be sent to a general office mailbox which is checked by our office staff several times a day. Our goal is to respond to requests within one business day. Please note that this form should only be used for non-urgent requests. Urgent requests should still be handled via the phone.