I understand Lemonlight’s current operating hours are Monday-Friday, 9 AM-5 PM, and visits outside of those hours may be considered after-hours.*

I understand Lemonlight will confirm pricing before services are provided.*

I understand this form is not for medical emergencies. If my child is experiencing a medical emergency, I will call 911 or seek emergency care immediately.*

I understand submitting this form does not guarantee a visit, diagnosis, prescription, or treatment. Lemonlight will review my request and follow up with next steps.*

I understand Lemonlight Pediatrics on Wheels does not replace my child’s primary pediatrician.*

I confirm that I am the child’s parent, legal guardian, or an authorized adult permitted to request care for this child.*

I agree that Lemonlight may contact me by phone, email, or text message about this request.*

I agree to the Terms & Conditions and Privacy Policy.*