Have any questions?

You can contact the Pre-Registration Department at 224-433-6505

Registration Forms

To expedite your check in process, please download, print, and fill out the following registration forms prior to your arrival. You will need your medical history and insurance information to complete these forms. Please download and print the forms.

  • To review your health history prior to your procedure please contact the nursing team at (224)433-6505

Bring the completed forms with you, along with your driver’s license and insurance card(s) on the day of your procedure:

  1. Clinical Assessment & Past History
  2. Medication List
  3. Acknowledgement of Receipt of Notice of Privacy Practices: English | Spanish
  4. Double Discharge Instructions
  5. EGD Discharge Instructions