New Patient Forms
All new patients will need to complete the forms in the packet available below. To save time during your first appointment, you can complete these forms in advance. Use the links below to access the forms and then print them out. Please bring your completed forms to the first appointment.
Your First Appointment
If you are a first-time patient, please plan on arriving early so that we can complete the necessary paperwork. For your convenience, you may print and complete the patient forms (found above) at home before your visit. Please bring the following items to the appointment:
- Insurance card(s)
- Referral forms (if required)
- Any required co-payment
- X-ray films that you may have
- Completed patient forms OR:
- Pertinent medical and surgical history information
- List of all prescription and over-the-counter medications that you are currently taking
Insurance and Payment Information
We are a provider for Medicare and most major insurance plans. We encourage all patients to confirm their coverage prior to making an appointment. Co-payments are due at the time of the appointment. You are responsible for any unpaid balance not covered by insurance.
Please call us with any questions regarding which insurance plans we accept or other billing concerns. Insurance coverage and benefit questions should be directed to your health insurance provider.
Hospital and Surgical Center Affiliations
- Central DuPage Hospital, Winfield, IL
- GlenOaks Hospital & Medical Center, Glendale Heights, IL
- Alexian Brothers Medical Center, Elk Grove Village, IL
- Oak Brook Surgical Center, Oak Brook, IL
- The Center for Surgery, Naperville, IL
We realize that our patients’ time is valuable and we make every effort to see patients at their scheduled appointment time. We ask that patients provide as much advance notice as possible when running late for an appointment or when cancelling. With this advance notice of cancellation, the time can be scheduled for another patient.
This summary and notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. The patient form packet shown above includes a form that asks you to acknowledge receipt of this notice.