Please call Surgical Associates at (847) 869-0522 to schedule an appointment, or fill in the form below with your contact information and when you would like to visit our office. Please pick a date at least one week from now or call us if your situation requires that you be seen sooner. We will contact you to confirm the appointment or reschedule if necessary.

Languages spoken: English, Spanish, Assyrian, Russian

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PATIENT INFORMATION

For new patients, please have your insurance policy number, insurer's phone number, and primary care physician (if applicable), ready when you call. Please see the our surgeons page for more information about each surgeon.

We ask that patients show up thirty minutes before their scheduled appointment to allow time for paperwork and notify us of any change in insurance coverage. If you have completed paperwork prior to arrival, please arrive ten minutes early so we may complete any final work necessary.

What to Bring

We ask that you assist us in serving you by bringing the following items with you to your appointment:

• Your driver's license or other valid picture I.D.
• Your medical insurance card(s)
• A list of current medications, including dosage information (frequency, strength)
• A referral from your primary care physician, if required by your insurance company
• Medical records (or have them faxed) as requested by our office
• X-Rays/Disks/Reports as requested by our office
• Payment

New Patient Forms

Below are links to our patient forms. These documents are required for all new patients. Filling out the forms now will save you time at your office visit and help your surgeon understand your medical history and symptoms.

• Patient Registration / Financial Policy
• Patient History
• Consent to Disclose
• Semi-Annual Update to Patient History (only if you have been seen previously)

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Full name
Address
City, State, Zip
Phone (work)
Phone (home)
E-mail address
Appointment Information
First Choice
morning    afternoon    evening
Second Choice
morning    afternoon    evening
I would like to schedule an appointment for: (please select all that apply)
Breast Surgery Cancer Surgery Colon or rectal surgery Colonoscopy or Gastroscopy (EGD) Gall Bladder Surgery Hernia Surgery Hemorrhoid Surgery Laparoscopic Surgery Skin and Subcutaneous Surgery Thyroid and Parathyroid Surgery Varicose Vein Surgery Vascular Access Other (please specify)
Please type your questions here: