New Patient Information
As your child or family member prepares to be admitted to The Children's Institute, take the time to look through and fill out our intake forms. They are essential to begin a patient's stay with us. More information can be found by following this link.
The best way to submit your forms is to fax or email them to Raegan Breisinger at 412.420.2166 or [email protected] respectively. If neither of those options is possible for you, please mail them to:
Attn: Raegan Breisinger
The Children's Institute
1405 Shady Ave
Pittsburgh, PA 15217
Forms can be found below:
1 Intake Process Letter
2 Clinical Intake Form
3 Authorization for the Release of Health Information
4 Insurance Demographics
5 Financial Assistance Form
Thank you for your cooperation!
For more information about an inpatient stay, please download our Patient Family Handbook.