Pediatric Urgent Care Fort Worth/La Gran Plaza
La Gran Virtual Visit
Open now
10:00am to 6:00pm CDT
(817) 750-7334
Hablamos español
REASON FOR VIDEO VISIT
CHOOSE A DATE AND TIME:
HAVE YOU BEEN TO PEDIATRIC URGENT CARE FORT WORTH/LA GRAN PLAZA BEFORE?:
No
Yes
PATIENT INFO:
Patient first name
Patient last name
Birth date: Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
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23
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31
Year
Mobile number
Email address
HOME ADDRESS
Home Address
City
State
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIP code
HOW DO YOU WANT TO PAY?
Insurance
Self-Pay
*
This clinic doesn't accept Medicare. You can still book with this clinic and use another insurance.
I have read, understand and agree to Solv Health’s
Terms of Service
,
Financial Relationships
, and
Privacy Policy
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I give my consent for the use of telemedicine in my medical care and have read, understand, and agree to these
Terms
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For emergencies
please call 911
