CONTACT · CENTRAL FLORIDA & TELEMEDICINE STATEWIDE

Request your Clarity call.

Please complete this form thoughtfully before scheduling your clarity call. I’ll review your responses in advance so we can use our 30 minutes to discuss your child’s concerns, whether my approach may be a good fit, and how I would structure the next phase of care.

This call is not a full medical consultation and does not include a detailed treatment plan. Individualized recommendations and a complete care plan are developed during the comprehensive consultation. Fields marked with an asterisk (*) are required.

About you & your child

Parent First and Last name

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Parent Date of Birth

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Parent/Guardian Email

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Parent Phone Number

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City and County

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Child's First and Last name

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Child's Date of Birth

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What is the name of your child's Primary Care Provider?

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What Brings you to Lumira?

What is your main concern you would like help with?

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What have you already tried or had evaluated?

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Your Goals & Next Steps

What are you hoping to get from working with Lumira?

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I understand that my child still needs a PCP for routine care and sick visits?

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I understand the discovery call is not a full medical consultation. It does not include review of records, labs, detailed medical history, or treatment recommendations. If Lumira is a good fit, we’ll gather your child’s full history before the comprehensive consultation.

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I understand this is a direct pay practice and that Dr. Rosario is out-of-network with all insurances.

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How did you hear about Lumira Pediatrics?

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