Insight Chicago Hospital – Book Appointments Online

Complete the form below to request an appointment at Insight Chicago Hospital and Medical Center.

Please note that your request will be processed within 1-2 business days. If you are experiencing a medical emergency, please call 911.

Is the patient a new patient or an established patient?

New patient Established patient

First Name

Last Name

Gender

Male Female Other Not Specified

MARITAL STATUS

Married Single Divorced Widowed Domestic Partnership Legally Separated Other

DATE OF BIRTH

ADDRESS LINE 1

ADDRESS LINE 2

CITY

STATE OR PROVINCE

ZIP OR POSTAL CODE

PRIMARY PHONE

EMAIL ADDRESS

RETYPE EMAIL ADDRESS

Has the patient been seen at Insight Chicago Hospital before?

Yes No

Department or Specialty

Reason For Appointment

Does the patient have health insurance?

Yes No

If yes, name of insurance

Type of insurance

HMO PPO POS EPO Medicare Other

Person Responsible for Patient Account

A 501(c)(3) Organization

2525 s Michigan Ave.
Chicago IL 60616

(312) 567-2000
Main Operator

(312) 567-2273
Direct Central Scheduling

(312) 638-8320
Fax Number