U18 Sports Medicine Appointment Request Form

Please fill out this form to request an appointment for a physician visit, rehabilitation services (including physical therapy and occupational therapy) or imaging services (including X-ray, CT scan and MRI).

A member of the U18 staff will contact you the next business day. You may also call (954) 265-6300 to speak with the office staff or schedule a physician visit. For physical therapy appointments please call (954) 538-5500.

* = Required

* Patient's Name:

* Parent's Name:

* Phone Number:

Cell Number:

* Email Address:

* Patient's DOB:

* Name of Primary Insurance:

* Please select what type of appointment you would like to schedule: Physician Visit
Rehabilitation Services
(including physical therapy and occupational therapy)
Imaging Services (including x-ray, CT scan, and MRI)

The above information is not medical advice and is provided for information only. You should not make any treatment decisions on the basis of this information.

U18 Sports Medicine is part of Memorial Healthcare System Network

U18 Sports Medicine Miramar: Suite 207 1951 SOUTHWEST 172 AVENUE MIRAMAR FLORIDA 33029 954.538.5500
U18 Sports Medicine Coral Springs: 5830 Coral Ridge Drive, Suite 207 Coral Springs, FL 33076 954-575-8940
Joe DiMaggio Children's Hospital MRI Center: 5830 Coral Ridge Drive, Suite 110, Coral Springs, Florida 33076 954-575-8201