For Patients

Forms & Policies

Registration form and office policies are ready to download. We would recommend you download and fill in 

the registration form ahead of your office visit.

Patient-Regsitartion-Form (pdf)

Patient-Financial-Responsibility (pdf)

Office-Policies (pdf)

Important info for patients

Your first visit

Our staff is very friendly and always ready to help with scheduling, insurance or anything else you may need during your time with us. Please read this information carefully to familiarize yourself with our office. 


  • New patients are requested to arrive 15 minutes prior to your scheduled appointment so we can expedite your paperwork and update all necessary information needed to see your physician.
  • We will need your identification and insurance card to complete your check-in process for every appointment. 
  • We accept self-pay patients 

Patient Forms

For your convenience we have online fillable forms, which can be printed or submitted online, we request you to get or submit these forms before your appointment.

Cancel or Reschedule Appointment

Please notify our office of any cancelation(s) 24 hours prior to a scheduled appointment, to reschedule your appointment(s). Please note there will be a fee of $50 for a no show. 

Copay, Deductible and Outstanding Balance

  • Our staff will inform you of any collectable copay, deductible or balance, which is due at the time of your appointment. We accept all major credit cards, check and cash. 
  • Statements and receipts will be provided on request. We also provide convenient payment plans for patients with High deductible plans, please contact our front desk for more details. 


We accept all major insurances, please call us to confirm if we take your insurance if it is not in the list. We can work with your insurance to get in network. 

  • Aetna 
  • Blue Cross/Blue Shield PPO
  • Blue cross Blue Shield community FHP
  • Blue Cross Blue shield HMO Amita / Hinsdale Site Number 257 and 488 ONLY
  • Cigna
  • Cigna Select HMO
  • Humana
  • Atena better health
  • Medicare
  • Medicaid
  • Meridian
  • Meritain
  • PHCS
  • United Healthcare

Self-Pay Patients are welcome

We have different packages for self-pay OB patients, Gynecology and Infertility patients. Please call us to get more information.


Call our office for refills 1-2 weeks prior to finishing your medications.