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Forms

New Patient Forms 

Welcome New Patients! To access the registration forms you need to submit when you arrive for your first visit, please click the appropriate link below.

Primary Care or Podiatry Patient

Use this form if you will be seeing a primary care provider or a podiatrist (foot and ankle doctor). Questions? Call 847-473-4357.

Behavioral Health Patient

Behavioral Health Patient Use the form below if you will be seeing a psychiatrist, psychologist, or counselor for Behavioral Health services. (Please use the “Child/Adolescent” form if the patient to be seen is under age 18.) Questions? Call 847-247-6910.

Reproductive Medicine and Immunology Patient

Use this form if you have an appointment with our Reproductive Medicine and Immunology. Questions? Call 847-247-6900. 

Reproductive Medicine and Immunology Patient

What to Bring to Your First Visit

  • Your completed registration packet
  • A list of any medications (prescription or over the counter, including vitamins and dietary supplements) you are currently taking
  • A photo ID
  • Your current health insurance card. A list of insurances we accept. Don’t have insurance? Please call us at 847-473-4357 prior to your first visit to discuss payment options.
  • Any co-pay your insurance company requires you to pay for an office visit (this information is usually printed on your insurance card). Co-pays are due at the time of your visit. We accept cash, checks, and credit/debit cards (VISA, MasterCard, American Express and Discover). Don’t see a co-pay listed on your insurance card? We recommend you call your insurance company at the toll-free customer service number listed on your insurance card to verify whether or not you owe a co-pay, and if so, how much.