For Patients

SURGEONS OF LAKE COUNTY

Information and Forms

Appointments

We make every effort to be on time, however, emergencies and other unforeseen events do arise that can cause our physicians to be late or to have to cancel their office appointments.  We respect your time and understand you may have had to adjust your schedule to make your appointment.  We do apologize in advance for any inconvenience this may cause and will notify you as soon as possible.   Please be sure your telephone numbers are kept current with our office.

Financial Information

Co-pays, co-insurances and/or deductibles are collected at time of service.  You have made a binding agreement with your insurance company to pay your portion of any charges accrued.  Anyone refusing to pay will be reported to his/her insurance company for breach of contract.  Any future visits will require payment in full at time of service.  Uninsured patients are expected to pay in full at time of service unless previous arrangements have been made.

We accept cash, check, money orders, Visa, Mastercard, Discover, American Express and Care Credit.  No post-dated checks will be accepted.  There is a $35 fee for any returned check.

For all statement, billing or payment plan questions, please call our office.

Clinical Information

During non-office hours should you have a medical emergency, please call 911 or go to your nearest emergency room.  If you are having an urgent issue and need to speak with our physician on call, call our office and the answering service will assist you by paging a physician.  Please understand the physician may be in surgery and may not be able to return your call immediately.

Refill requests are handled during normal office hours.  Prescriptions will not be refilled during non-office hours.  Please have your pharmacy fax a refill request form to our office.

Forms and Medical Records Request

There is a $15 charge for each disability and FMLA form.  This fee must be paid prior to these forms being completed.  Due to the excessive requests by employers and insurance companies, it is our policy to require 7 business days for the completion of these forms.  Duplicate requests will not expedite the handling of these forms.  Please notify your insurance company/employer of our policy.

We comply with all HIPAA regulations with regards to medical records.  Medical records are released with written consent by the patient or legal guardian within 30 days.  Medical records will be released free of charge to other treating physicians as a professional courtesy.  Any other requests for medical records are subject to reproduction and shipping fees in accordance with state and federal laws.

General Information

Our staff is important to us and we ask that our patients respect our staff.  Any patient found abusing our staff will be asked to find another physician.

In addition, we ask that you respect one another.  Please refrain from wearing strong perfumes, lotions, colognes or any other item that can cause our patients, staff, or physicians to suffer from allergic reactions or respiratory distress.  We reserve the right to ask anyone to leave immediately for the safety of those around them.

Our office location:
Winchester Court
1870 W Winchester Road, Suite 112
Libertyville, IL 60048

Our phone and fax numbers:
Phone: (847) 816-7495
Fax:   (847) 816-7497

Our office hours:
Monday-Friday  8:30AM – 5:00PM

If you do not have a scheduled appointment, please call before leaving for the office.  We do occasionally adjust our hours to accommodate good or bad weather conditions.

FORMS

Using our on-line internet services we have made available from our practice portal website, you can communicate with our office anytime that is convenient to you for such things as appointment requests, medication renewal requests, and access to your medical information. You will need to register your email address with our office or you will not be able to use this feature.

To begin using these services, you will need to create a secure account on our website:
https://www.myhealthrecord.com/Portal/SSO

Click to Download New Patient Forms

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