Outpatient
Riley Pediatric Cardiology
4.7 out of 5 stars
(235 ratings)
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Riley Children's Health Medical Office
621 Memorial Dr., Suite 612
South Bend, IN 46601
Hours
Opens at 8 am
Doctors at This Location
Forms & Resources
Authorization to Release Medical Records
Complete this form when you’d like for medical records to be released to another entity.
Consentimiento General (Español)
Se le pedirá que revise y firme este consentimiento para recibir atención de nuestros médicos y personal.
Consentimiento Para Comunicaciones Preferidas (Español)
Complete este formulario para permitir que familiares y amigos puede recibir información sobre su salud.
You will be asked to review and sign this consent to receive care from our physicians and staff.
Preferred Communication List (English)
Complete this form to allow family and friends to receive information regarding your health.
What to Bring
- Your child’s current insurance information
- Form of identification
- List of all medications your child is currently taking, including how many times per day and the dose (be sure to include both prescription and over-the-counter medications)
- List of questions or concerns for your child’s doctor
- Medical records (e.g. X-rays, lab test results, etc.)—your referring physician may have already sent these records, so be sure to ask your doctor before your child’s visit with us
- Form of payment for any deductible and/or co-insurance required by your insurance plan