Please fill out the form below to book an appointment with Tiny Tusks Pediatrics Clinic. All fields marked with * are required.
Patient Full Name *
Parent/Guardian Name (if patient is a minor) *
Email Address *
Phone Number *
Preferred Appointment Date *
Preferred Appointment Time * 9:00 AM10:00 AM11:00 AM1:00 PM2:00 PM3:00 PM4:00 PM
Reason for Visit *
Insurance Details (Optional)
I consent to the collection and secure handling of my personal health information in accordance with HIPAA and Australian privacy laws.
Your information is securely handled in compliance with HIPAA and Australian privacy regulations. A confirmation email will be sent upon submission.