Now Available - ER Video and Scheduled In-Person Visits
Kaleida Health logo


Pediatric Specialty Medical and Surgical Service Referral Form - pdf
This form was designed to improve access and communication between the primary care office and Hospital based specialists about patients who require consultation. By completing and faxing this simple one page form,attaching a copy of the Healthy Net insurance verification face sheet and copies of any relevant labs the referring doctor can facilitate the process of arranging for specialty appointments.Once this material has been faxed parents can be advised to call the respective specialist and request an appointment. Please note this pathway is not the only way to request consultation. You may continue to use whatever other avenues you are most comfortable with.

Direct Admit Form - pdf
The Direct Admission Team has developed a pathway to admit non-emergency private pediatric patients to Women and Children’s Hospital of Buffalo.  Primary Care Pediatricians are able to admit patients that have been evaluated in their office the same day directly to the inpatient unit following the care pathway provided they meet outlined criteria.  The patients must be stable and not require emergency intervention but require hospital admission for ongoing medical care.