Sign Up for Our Programs

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On this page, you can sign up for programs and proceed to payment. We use Paypal as our online payment processor. Please note that you do not need a Paypal account. Paypal also accepts major credit cards. For more information, please click on the Paypal logo at the right.

EB Pediatric Resources requires that each family fill out a release of liability form. Please also note the Playgroup Rules. These rules must be followed for the safety of the children.

Billing Policy

Our fees are based on professional and community standards. We ask that patients pay for professional services and supplies at the time services are rendered. Financial responsibility for services lies with the patient; however you may request a HCFA form which you can then submit directly to your insurance company for possible reimbursement.

If you have any questions about our fees or payment policy, or prefer to sign up over the phone, please contact us at 312-458-9865 or pediatricresources@sbcglobal.net

Select Program:
Parent's Name:
Child's Name:
Telephone: (e.g. 123-456-7890)
Email:
IMPORTANT: If you're signing up for Developmental Playgroup, please type in your choice of session and day of week (e.g. Spring session/Friday) in the box below. If unsure, type "contact me".
Playgroup Session/Day
I have read the waiver and fully understand that it is a release of liabililty. I understand that by signing up through this web site, I agree all the policies of EB Pediatric Resources as stated in the waiver.