For your convenience, we are pleased to offer Online Appointment Requests. Complete the following form, and we will contact you within two business days to confirm your appointment.

Online Appointment Requests are intended for established patients for non-urgent, non-same-day appointments. If you are sick, needing a same-day appointment, or wish to cancel or reschedule an existing appointment, please call our office directly. Our office requires a 24 hour notification for appointment cancellations. :

Burlington Pediatrics: 336.228.8316
Burlington Pediatrics West: 336.524.0304
Mebane Pediatrics: 919.563.0202

Please be advised that the following request is not SSL encrypted for information security. As always, if you are experiencing a life-threatening emergency, call 911 and seek prompt medical attention.







Preferred Method of Contact:


Appointment date and time:
required: choose at least one date or check First Available

First Available

Specific Dates:

1st Preference:


2nd Preference:


Office Location:

Burlington Pediatrics: 530 West Webb Avenue
Burlington Pediatrics West: 3804 South Church Street
Mebane Pediatrics: 943 South Fifth Street

Provider Preference:

@ Burlington Pediatrics

@ Burlington Pediatrics West

@ Mebane Pediatrics


Security Code:

Your appointment request is incomplete; please make sure all required fields are filled out correctly.