New Patient Information & Forms For
Weil Foot & Ankle Institute

PATIENT INFORMATION

Weil Foot & Ankle patient information includes detailed information on your visit, patient forms, new patient information, and insurance information.

YOUR VISIT

If you are a new patient, please arrive to your appointment early in order to complete the registration process. In addition, please bring the following:

• Completed New Patient Forms
• Driver’s License or State ID
• Referral (If Required by Insurer)
• Insurance Information
• Copies of Operation Records, Medical Records, X-rays, MRIs, and CT Scans from Prior Doctor Visits
• A List of Current Medications and Any Known Allergies

We ask our patients to complete these forms before their first appointment. Please click on the link below, print the forms, and fill them out before coming for you first visit.

To view the forms, you will need Adobe Reader. You can download Adobe Reader for free at www.adobe.com.

DIRECTIONS

Please note: many of our offices now have kiosks in their locations which allow for digital forms. If you do not see new patient forms on the link below for the location you are visiting, we will provide the forms to you in digital form.

• Bannockburn IL Directions
• Glenview IL Directions
• Lakeview IL Directions
• Lemont IL Directions
• Libertyville IL Directions
• Oak Park IL Directions
• Ravenswood IL Directions
• Roselle IL Directions
• Rush IL Directions
• Rush IL New Patient Forms
• South Loop IL Directions
• Tinley Park IL Directions

To view the forms, you will need Adobe Reader. You can download Adobe Reader for free at www.adobe.com.

ADDITIONAL FORMS

• Notice of Privacy Practices
• Medical Record Release Form
• Request for Confidential Communications
• Request for Correction of Healthcare Information
• Restriction Request Form
• Financial Policy
• Temporary Parental Power of Attorney Form
• Registration Form

To view the forms, you will need Adobe Reader. You can download Adobe Reader for free at www.adobe.com.

APPOINTMENTS

Please call the main office at (847) 390-7666 to make an appointment in advance. If you are unable to keep your appointment, please call us as far in advance as possible so we can use that time to see another patient in need of care.

We make a sincere effort to adhere to our appointment schedule and appreciate your patience if we are late due to emergencies or hospital surgery.

INSURANCE INFORMATION

We accept most major insurance plans. If you have questions regarding your insurance, please contact us at (847)666-5504.

FEES & PAYMENTS

We make every effort to decrease the cost of your medical care. Therefore, we request payment arrangements for all office services at the time they are rendered unless prior arrangements have been made. We accept cash, checks, American Express, MasterCard, Visa, and Discover for your convenience.

If we are a participating provider of your insurance company, we will bill them. However, payment is the patient’s responsibility. We will help in any way we can to assist you in handling claims.

Weil Foot & Ankle Institute has provided care and treatment to more than 200,000 patients in the past 49 years. The Foot & Ankle Surgical Center, a fully licensed and Medicare Approved Ambulatory Surgery Center, was opened in 1994. Patients requiring surgical procedures are able to receive care in an ambulatory surgical setting rather than in a hospital. To date, more than 30,000 surgical procedures have been performed in the Foot & Ankle Surgical Center.