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Request an Appointment

To request an appointment, please complete all of the fields below and press Submit. If you need to request an appointment for dyslexia/learning disorders, please visit the Center for Dyslexia Application Process section of the Dyslexia page.

If you are a current Scottish Rite for Children patient with myChart access and have a question for your provider, please access your myChart patient portal account.

Note: If you are a referring health care professional, please complete the Referring Health Care Professional Request form.

Patient Details
Current Patient
Preferred Location and Reason for Visit
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Reason for Visit
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Contact Information
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