PDC Callback :: Nationwide Children's Hospital
Information Gathering for Physician Direct Connect
Please complete the form below and click "Submit".
Practice Information
Practice Name *
Office Address
Front Line Phone #
Fax #
Preferred backline phone number for Physician Direct Nurses to call, with specific instructions (i.e. 614-777-7777 option 2) *
Preferred phone number for calls after 5 pm or on a weekend/holiday
Please list the physicians in the practice. A cell phone may be submitted if desired.
Physician Name 1 *
Cell Phone
Physician Name 2
Cell Phone
Physician Name 3
Cell Phone
Physician Name 4
Cell Phone
Additional Physicians/Cell Phone (no more than 10)
Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000