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Mattel Children's Hospital UCLA
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UCLA Pediatric Pulmonology


UCLA Pediatric Pulmonology Patient Surveys


Pediatric Pulmonology Division
10833 Le Conte Avenue, 22-387 MDCC
Los Angeles, CA 90095
Phone: (310) 267-0606 Fax: (310) 794-7338
Appointment: (310) 825-0867 Page Operator: (310) 825- 6301



To plan for your child's appointment, please print out and answer the survey questions.

  • If you are new to UCLA or you are seeing a new pulmonary doctor, then complete the New Patient survey (Spanish version) Email Consent (Spanish version) and the Contact Sheet (Spanish Version).
  • If you are seeing Dr. Okelo for at least the 2nd time, then answer the Established Patient survey (Spanish version) and the the Contact Sheet (Spanish Version). Return the completed form to your doctor at the time of your appointment.
  • Your answers will help the physician quickly understand your child's problem
  • Answering the survey will make more time available to focus on the main issues and to answer your questions.
  • The questions are meant simply as an overview.
  • The doctor will probably ask you to elaborate on several of the issues
  • Please to tell your doctor anything else you wish to inform him/her about your child's case.
  • If you have any questions, please feel free to call (310) 267-0606.
  • If you need to change the appointment, please call the Pediatric Appointment
  • Center at (310) 825-0867 or our Administrative Assistant at (310) 825-5930.


Elaine Harrington, RN, BSN, AE-C
Department of Pediatrics
Division of Pulmonology
Mattel Children's Hospital - UCLA