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Patient Information

What to Bring to Your Appointment
Patient Forms
Insurance and Payment Information
Notice of Privacy Practice
Hospital Affiliations

What to Bring to Your Appointment

• Your insurance card
• Physician referral forms if required by insurance
• A list of current prescriptions and/or over-the-counter medications you are taking, including dose and frequency
• Pertinent information about your medical and surgical history
• Any recent x-rays or appropriate records you may have

New Patient Forms

Please download, print and complete the forms you need to bring with you for your first appointment. It will save you time the day of your appointment. Get the forms by clicking on the link below:

• Medical History Form[PDF]
• Patient Registration Form [PDF]
• Financial Policy Form [PDF]
• Privacy and Consent Form [PDF]

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Insurance and Payment Information

If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at the phone number below. Questions regarding your coverage and benefits should be directed to your employer or insurance company.

We accept Medicare assignment, and commmercial insurance plans.

We accept the following managed care plans as of 3/01/02. However, to ensure that your plan includes our practice, please check with the office.

• Admar (Med Network PPO)
• Aetna HMO
• Aetna PPO, EPO & POS
• BCBS Blue Choice POS
• BCBS Blue Choice PPO
• Blue Advan. PPO
• Blue Advan. MPP
• CAPP CARE/Beech Street PPO
• CCN PPO, POS, WC
• CIGNA HMO/POS
• CIGNA PPO/EPO
• First Health Network PPO
• Health Marketing PPO
• Health Network PPO, EPO (Wellmark)
• HFN PPO, EPO
• HMOIL (Site # 124)
• Humana Health Plans PPO, POS
• Humana HMO Gold Plus (referred by an Advocate Health Center PCP)
• Humana Premier HMO
• Multiplan PPO
• One Health Plan PPO
• Preferred Health Network PPO/Health Star (PPONext)
• Preferred Network Access PPO/EPO
• Preferred Plan PPO
• Private Healthcare Systems PPO
• Rush Prudential PPO
• Unicare PPO
• Unicare/Rush Prudential HMO
• United HealthCare HMO
• United HealthCare Open Access PPO
• United HealthCare Options PPO
• United HealthCare Premier HMO
• United HealthCare Select HMO
• United HealthCare Select Plus POS

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Privacy Practices

Notice of Privacy Practices for Neurology Specialists of Northern Illinois.
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.

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Hospital Affiliations

• Advocate Lutheran Hospital in Park Ridge, IL
• Northshore University Heath System in Skokie, IL
• Holy Family Ressurrection Health Center in Des Plaines, IL