Request an Appointment at Children’s Health℠ Specialty Center Southlake 817-730-5437 Appointment Request Form Already a patient? Click here to login. Referring provider who wants to attach records? Guardian's Name: Please Enter Guardian's Name Patient's Name: Please Enter Patient's Name Date of Birth: Please Enter Date of Birth Gender: Male Female Phone: Please Enter a Phone Number Email Address: Please Enter an Email Address Condition/Treatment: Please describe the specialty or service you are seeking. Please note doctor or location preference. Referring Provider Information: I want to receive health information emails from Children's Health. Please allow 2 business days for a response. Call 911 for emergencies.