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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.

Primary Care or Podiatry Patient

Paquete de Registro del Paciente

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.

Behavioral Health Center - Adult Patient

Behavioral Health Center - Child/Adolescent Patient

Reproductive Medicine Patient
Use this form if you have an appointment with our Reproductive Medicine Center. Questions? Call (847) 247-6900.
Reproductive Medicine Center 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. Click here for 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.