Patient Info

Physician Appointment Forms

Please print the following forms:

We must have the insured’s date of birth and social security number. If you do not give out your social security number, please let us know.
However, there are no exceptions for the date of birth of the insured.

We require this information in order to file claims in a timely manner.

You will need to bring these forms to your appointment, along with an insurance card and photo
identification.

IPL Consultation

Please print the patient information and consent form. We require a signed consent form at the time of consultation to ensure that you have read the form and that all your concerns have been addressed. Signing the consent does not mean that you must have treatment.

Laser Hair Removal Consultation

Please print the patient information and consent form. We require a signed consent form at the time of consultation to ensure that you have read the form and that all your concerns have been addressed. Signing the consent does not mean that you must have treatment.

Microdermabrasion Treatment

Please print the patient information and consent form. We require a signed consent form at the time of consultation to ensure that you have read the form and that all your concerns have been addressed. Signing the consent does not mean that you must have treatment.

We participate in the following plans:

  • Aetna
  • Beech Street PPO
  • Blue Cross/Blue Shield PPO
  • Blue Choice
  • Blue Cross/Blue Shield HMO IL
    (site 447 & 284)
  • Cigna
  • First Health/Coventry
  • Great West
  • HFN
  • Humana
  • Medicare
  • PHCS/Multiplan PPO
  • Unicare/Healthlink PPO
  • United Healthcare

Prescription Refills

To request a prescription refill please contact your pharmacy and ask them to fax us a refill request to (847) 272-4434 or send it electronically.

For products purchased in our office please call our office at (847) 272-4433.