UH Rainbow Elyria Pediatric Care Services

As a parent or legal guardian, you can manage your child’s online health information. Visit the MyChart for MyFamily section of our FAQs to learn more.

Please allow 3-5 business days for medical forms (for school, sports or camp) to be completed. Forms must be dropped off at the front desk during normal business hours or faxed anytime. Your portion of the form should be filled out completely, including your child’s name and date of birth. If the form requires a doctor’s signature, the child must have had a physical within the last year or it cannot be signed. Please remember to schedule your child’s physical yearly.

Forms for School, Sports or Camp

1. Forms must be completely filled in by the parent, including exact name of medications on the bottle and form, ie: pill, liquid, and dosage.
2. If your child is seen by a specialist, please have the specialist sign the forms.

• Patient Registration Form
• Pediatric Health History
• Parent/Guardian Consent to Treat Minors
• UH General Consent Form
• Parent/Guardian Personal Health Record Account Request Form
• Authorization for Release of Medical Information
• Ohio High School Athletic Association Pre-Participation Physical Exam
• ADHD Vanderbilt Parent Form
• ADHD Vanderbilt Teacher Assessment Form

We realize that not all symptoms/concerns you may have regarding your child will require an appointment. We do offer telephone advice, but ask that you keep in mind that some questions will require a return call before the end of the business day.

You can ask your provider questions via the MyChart app. Message responses may take up to two business days. If this is an emergency, please call 9-1-1.
Login or register for MyChart.

We understand that becoming a new parent may raise many questions and that choosing a physician for your baby is important to you. To help answer some of those questions, we offer "Meet and Greet" appointments with either of our physicians. These appointments are limited throughout the day so please call at least one month before your due date to schedule.

If you would like us to see more than one child, please schedule both of them when you make your appointment. Without an appointment, we may not be able to see a sick sibling right away, and you may be asked to wait while the provider sees a scheduled patient who may be waiting. We also ask that you let the receptionist know all of the concerns you would like to discuss with the physician so that the appropriate amount of time is scheduled. Concerns not mentioned when scheduling an appointment may need to be addressed at another visit.

To keep your children healthy, it is important to bring them in for regular checkups. We recommend that you call our office 4 weeks in advance so you may choose the date that best fits your needs.

UH MyChart allows us to e-prescribe any prescriptions at your appointment within seconds. This will allow us to keep better track of all medications you are currently or have been taking, even if prescribed by another office. For prescription refills please try to give as much advance notice as possible; feel free to leave a message for the nurse, we ask that for most refills your child's physical is up-to-date.

Medications that are more closely regulated by the FDA have different requirements for prescribers. We are required by law to see your child regularly to monitor medication use and usefulness.

University Hospitals no longer accepts cash or check as in-person payment for services. You can pay by card (credit, debit, HSA, FSA, etc.), Apple Pay or Google Pay. You can also use UH MyChart to pay your bill online or before your appointment during eCheck-in. We accept checks for payment by mail.

You can now quickly and easily pay your provider bill online using our convenient online bill pay tool.

We accept most insurance carriers. Please have your card with you at the time of the visit. If we file your claim, you are responsible for only the co-pay at the time of the visit. If we are not a provider for your insurance, if you are not insured or we do not file with your insurance company, you may be responsible for the entire charge at the time of service. It is your responsibility to know your insurance benefits and to inform the staff of multiple carriers.