Please arrive 15 – 20 minutes before your appointment time to complete patient registration information. For your convenience, our patient registration forms are available for you to download and complete prior to your arrival.

Forms

Automobile No-Fault Liability

Credit Card Installment Plan

Credit Card Installment Form

Identity Theft Protection

Worker's Compensation Patient Info

Patient Registration Form

Consent

What Do I Bring With Me?

To avoid delays in your appointment, please make sure you bring the following with you:

• Completed and signed forms that you may have downloaded from above
• Current insurance card(s) - Click here to find a listing of accepted insurances and our financial policy
• Any MRI or x-ray films and reports from other doctors or hospital emergency rooms
• A list of the medications you are taking
• Co-pay (if required by your insurance)

Location & Hours

2200 Ft. Jesse Rd. Suite 250
Normal, IL 61761
(309) 454-1616

1806 N. Market St.
Champaign, IL 61820
(217) 355-1616
Fax: (217) 356-7167

2110 Fox Drive
Champaign, IL 61820
(217) 355-1616
Fax: (217) 356-7167

More Contact Info