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Patient Information

Appointments | Patient Forms | Insurance and Payment Information
Prescription Refills | Laboratory Services | Hospital/Facility Affiliations | Privacy Practices

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Appointments

All patients are seen by appointment only. Appointment times are approximate because each patient receives individualized attention by the doctor and staff. The doctor may also need to address emergency cases during the day and these emergencies may delay your appointment. Please try to understand if you are asked to wait for the doctor. We will do our best to keep your waiting time to a minimum.

How You Can Help

If you are a new patient, please be prepared to complete a patient demographic sheet and medical history form. Some patients may be asked to fill out additional forms if their condition warrants it. Bring any and all valid medical insurance cards for us to copy. We copy insurance cards at least twice a year. Even if your insurance has not changed you may have received a new card in the mail with a new group number, mailing address, or telephone number that are important to us. Please be aware we want to make sure that you maximize your benefits and current insurance information is a must. For your own protection, when you request copies of your medical records we will require you to fill out a release form. This procedure will ensure that no one other than you or your designee has access to your medical records. The physicians and staff make every effort to keep on time. However, emergencies can put our scheduled office hours behind. If you need to leave, please notify the receptionist so that she can re-schedule your appointment. If you bring children with you please remember that they are your responsibility and should not be allowed to disturb other patients in the reception area.

Patient Forms

For your convenience, you may view, print, and complete the following patient forms before your office visit.

• New patient registration form
• Patient medical history - Male patients
• Patient medical history - Female patients
• Financial Policy

[information on accessing and printing forms]

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Insurance and Payment Information

We participate in the following insurance plans.

Blue Cross Blue Shield PPO Blue Advantage PPO Blue Choice CCN/First Health Cigna Healthcare Health Network Health Star

Humana Health Plans Medicare PHCS Preferred Plan Unicare United Healthcare

Co-payments are required at the time of any billable service (except lab work). We accept cash, check, Visa, MasterCard.

Once service has been provided, you will receive a monthly statement from our office that will help you follow the progress of the insurance claim. Deductibles and co-insurance are your responsibility and are due within 30 days of your statement.

There is a $25 surcharge for returned checks. Returned checks will be filed with our collection agency and subsequent payment must be with cash or certified funds.

We try to accommodate all patients and therefore missed appointments or cancellations not made within 24 hours will be assessed a $25 fee.

These financial policies are subject to change without notice.

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Prescription Refills

Prescription refills should be requested at least 3 days before your current prescription is finished. When calling for a refill, please have the pharmacy name and telephone number available for our nurse. Refills should only be requested during regular office hours. Please consider the holiday schedule when following your medication routine, as the office is closed on all major holidays. Pharmacies are encouraged to fax their requests to us at 708.354.4552.

Laboratory Services

All laboratory tests require an appointment.
We will send your test to the designated laboratory that your insurance requires. We may ask you to provide us with another copy of your insurance card so that we may send them with your specimen. Also keep in mind that some HMO type insurances require that you have your test done at your primary physician's office.

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Hospital/Facility Affilliations

Our physicians are affiliated with the following medical facilities:

• LaGrange Memorial Hospital, LaGrange, IL
• Hinsdale Hospital, Hinsdale, IL
• United Shockwave
• Chicago Prostate Center

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Privacy Practices

Notice of Privacy Practices
This 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.