Request an Appointment

New Pediatric Visit

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

Appointment Preferences

Preferred Locations NorthShore Medical Group
6450 W. Touhy Ave.
Niles, IL 60714

Wheelchair accessible location.

Tel: 847.663.8163

Fax: 847.663.1024

NorthShore Medical Group
9977 Woods Dr.
Suite 200
Skokie, IL 60077

Wheelchair accessible location.

Tel: 847.663.8163

Fax: 847.663.1024

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

Download the NorthShoreConnect app to access your health information on your mobile phone.

A Teaching Affiliate of