Appointment | Chicagoimmediatecare.com

Appointment

Online Appointment

Patient Information
First Name*:
Middle Name:
Last Name*:
Gender:
Contact Information
Contact Name (if different than patient name):
Address*:
City*:
State*:
Zip Code*:
Telephone*:
Email Address:
Insurance Information
Primary Health Insurance Name:	(Please specify Other)
Primary Health Insurance Type:
Policy # :
Group # :
Primary Holder First Name:
Primary Holder Middle Name:
Primary Holder Last Name:
Primary Holder Name:
Insurance Claim Phone #:
Secondary Health Insurance Type (if any):
Policy # :
Group # :
Insurance Claim Phone #:
Appointment Information
Primary Care Provider or Referring Physician’s Name:
Primary Care Provider or Referring Physician’s Phone Number:
Have you ever had an appointment at Kendall Immediate Care?
Do you have a particular physician that you would like to see?
If yes, please enter that physician’s name here:
Have you seen this physician before?
Type of service requested:
Reason for appointment:
Time Preference
Day of week:	or
Time of day:
Additional comments:
Your appointment will be made by the time you come into the office. For additional questions about your appointment, please call the Chicago Immediate Care at 773 – 224 – 4800. What is an immediate care clinic? An immediate care clinic is a convenient alternative when your regular clinic is closed, or you cannot see your usual physician as soon as you would like to. Chicago Immediate Care is open late nights, seven days a week making it convenient to receive quality healthcare. You can take advantage of the services at an immediate care clinic for any illness or injury, including: sore throats, ear infections, minor burns, cuts, sprains, fractures, and bruises. You can even use immediate care as your primary healthcare provider. Who will care for me? The professional and experienced staff, nurses, and physicians will provide you with quality care centered around your needs. Your care and comfort are a priority to us, and we provide all of our services keeping your convenience in mind. Is an appointment or insurance necessary? You do not have to make an appointment to see a physician, walk-ins are welcome. We accept all healthcare plans, but insurance is not necessary. We accept cash, checks, and credit cards. Chicago Immediate Care is dedicated to providing the highest quality of non-urgent healthcare services. We are conveniently open late nights, 7 days a week, 365 days a year. Each staff member is committed to providing patients and their family with compassionate care and service—making patients the highest priority. Doctors and staff ensure that patients’ concerns are resolved. Each patient is treated with courtesy in an efficient manner. Modern facilities, highly qualified doctors, and a safe environment provide a comforting experience. Responsible staff members and doctors inform patients in an accurate manner, while upholding confidentiality. The combination of options, convenience, and quality make Chicago Immediate Care a patient-centered healthcare facility.

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