Schedule a Well-Check Up
If you would like to schedule a well-check up, submit the form below with your information, and we'll call you back soon! Alternatively, you can call our phone number (on the "Contact Us" page) and leave a message with the information below.

** If you would like to see Dr. Chris or Dr. Becky, please make sure that your insurance card lists either "Dr. H. Christopher Lim" or "Dr. Beckilyn Lim" as your primary care physician (PCP)! **

Patient Name *
Your answer
Patient Date of Birth *
(MM / DD / YYYY)
Your answer
Your Name *
(To schedule an appointment, you must be the legal guardian of the patient or authorized by the legal guardian on the patient's "permission slip," which you can download from our "Forms" section.)
Your answer
Your Relationship to the Patient *
Your answer
Contact Number *
(What is the best number to reach you?)
Your answer
Who is your primary care physician? *
(We only schedule appointments for Dr. Chris Lim and Dr. Becky Lim of Port Warwick Pediatrics, Ltd.)
When do you want to schedule your appointment?
(Which month do you prefer? Which day(s)? What time of day?)
Your answer
When was your last physical?
(Note that some insurance companies require that your well-check-ups are at least one year after your previous check-up. If you need to schedule a well check-up before a year has passed, please ask permission from your insurance company to approve your visit.)
Email Address
Your answer
Would you like to join our mailing list?
(We will only use this to contact you about information pertaining to our office.)
Additional Notes
(Comments, Questions, and Suggestions are all welcome!)
Your answer
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