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Ask the Pediatrician!

Do you have a question regarding your child for Dr. Jim Sears? We want to hear your stories and questions! Please only write if you are willing to appear on TV. Be specific about your story and your question.

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first name:	*
last name:	*
birthday:	*
E-mail address:	*
street address:	*
additional address:
city:	*
state:	*
province/Region (if not in U.S.):
zip/Postal code:	*
country:	*
day phone:	*
evening phone:
cell phone:
are you willing to appear on the show:	Yes No *
children's ages?:

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