KidsCare Link physician & office staff registration form

Is this a request for a physician or for a Delegate?

is this a request for a provider or for a delegate?

Requestor Type:

Access Information

access information

Application Requested:

KidsCare Link

Requester Information

requester information

Requester First Name:

Middle Initial:

Requester Last Name:

Phone:

business email address:

(you must enter a business email address. If you do not have one, please enter your manager’s business email address. We cannot accept Yahoo, Hotmail, Gmail or other private email accounts. This is a REQUIRED field.)

Clinic Location Information

clinic location information

Office Name:

Address:

City:

State:

Zip Code:

Office Phone:

Fax:

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Click here to read the policy!

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10/29/25 | news article Our kids and families are counting on us: Vote YES on Issue 1

11/01/25 | blog post how to support kids from military families Use our free download to start the conversation with kids from military families about their unique needs

Debbie Feldman, president and CEO, announces retirement from Dayton Children's

Deborah A. Feldman, president and CEO of Dayton Children’s Hospital, will retire June 30, 2026, after 14 years of transformational leadership.

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