Request an Appointment

New Medical or Surgical Specialist Visit

Please provide the following information and we will contact you to schedule your appointment.

Appointment Preferences

Preferred Locations NorthShore Medical Group
9933 Woods Dr.
Suite 200
Skokie, IL 60077

Wheelchair accessible location.

Tel: 847.663.8060

Fax: 847.663.1027

NorthShore Medical Group
1515 Sheridan Rd.
Suite 31A
Wilmette, IL 60091

Wheelchair accessible location.

Tel: 847.663.8060

Fax: 847.663.1027

Preferred Day(s) and Time(s) Any
Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.

Any
Morning Hours (Before 11 AM)
Mid-day (11 AM - 3 PM)
Afternoon (3 PM - 5 PM)
Evening (5 PM - 7 PM - when available)

Your Information

Name *

Street Address *

City *

State

Zip Code *

Contact Information *

Please contact me by Phone

Please contact me by Email

Date of Birth *

Are you an existing patient? *

Insurance Carrier *

Additional Questions

Name of preferred physician

Reason for this visit *

Submit Request

Evanston Hospital | 847.570.2000
2650 Ridge Avenue, Evanston, IL 60201
Glenbrook Hospital | 847.657.5800
2100 Pfingsten Road, Glenview IL 60026
Highland Park Hospital | 847.432.8000
777 Park Avenue West, Highland Park, IL 60035
Skokie Hospital | 847.677.9600
9600 Gross Point Road, Skokie, IL 60076

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