Forms and Policies



Anyone who is more than 10 minutes late to their appointment will be asked to reschedule. If you need to cancel your appointment please give our office 24 hour notice if possible, any missed appointments will be charged a $50.00 fee.

*Appointments that were scheduled for longer time slots may be charged an increased fee.

Patients who miss multiple well child visits may be dismissed from our practice. It is important to bring your child in for their routine well child visits.

Please note that a sick visit is not the same as a well child visit and cannot be combined in the same visit.

Please give our office up to 1 full business week to complete any forms, letters, or prescriptions you may need filled out and signed by the physician.

*Specialist referral letters may take up to 2 weeks to be completed.

Patients transferring out of our office will need to fill out a transfer request form and fax to our office at (847) 695-9989. Our office charges a $35.00 fee for full records including immunizations and a $10.00 fee for just immunizations. Please give our office up to 15 business days to fully transfer records.