New Patient Registration

Welcome
Thank you for scheduling an initial appointment with our practice.  We hope to make the process a comfortable one for you.

To expedite the check-in process, please print and fill out the Patient Registration form available in two formats below. 

Please fax or mail this form to our office prior to your appointment. Our fax number is 312-654-5288. It is important that you include a copy of both the front and back of your insurance card.

If you are unable to send us the information in advance, you may bring the Patient Registration Form on the day of your appointment, however please arrive at least 30 minutes prior to your appointment time to enable us to complete the necessary paper work prior to your visit.  Also, if we have not received the information in advance, please make sure you bring your insurance card with you. If you do not bring in your insurance card at the time of your visit, or if your plan is not a plan we participate in, you will be asked to pay at the time of service.

In the event that you must cancel or change your appointment, please give us the courtesy of at least 24 hours notice. We allow a significant amount of time for a first appointment which goes unused in the event of a last minute cancellation or failure to keep the appointment.  Therefore, we have instituted the following policy:

**If you cancel your first appointment less than 24 hours prior to your visit, there will be a $100.00 deposit required to reschedule a new appointment. This deposit will be voided on arrival. If you cancel or fail to make the second appointment, your deposit will not be refunded and no further appointments will be made.

If you have any questions about our billing procedures or are unsure if we participate in your insurance plan, please call 312-654-5292 prior to your visit and a member of our billing department will be happy to assist you.