Request an Appointment

If you would like to request an appointment with one of our Northwestern Medical Faculty Foundation physicians, you may contact us in one of the following ways. If this is an emergency, call 911 or go to your local emergency room.

• Call the main telephone number for the Department in which you would like an appointment. Click here to obtain the Practice Phone Numbers Quick Reference Guide.



• Call our Patient Services Center at 312-695-1920, TTY:(312) 695-3661 for assistance with selecting a physician. The staff in the Patient Services Center is familiar with the services provided by each of our departments.



• Complete the form below and you will be contacted by our Patient Services Center within one to two business days to schedule an appointment. You must be 18 years of age or older to use and submit this form.

If you call to make an appointment, please have the following information available:

• Name
• Address
• Telephone number
• Social Security number
• Name of your referring physician
• Insurance information

Appointment Request Form

Your appointment request contains confidential health information. The information you send will be transmitted over the Internet and will not be secured by encryption. It is possible that unauthorized individuals could intercept this information. If you are uncomfortable sending this information electronically, please call to schedule an appointment. By transmitting information to us over the Internet or by e-mail, you acknowledge and accept the risk of sending the information.

Required fields are indicated with an asterisk(*). This is the minimum information needed in order to contact you and schedule an appointment.

Name
*

Email Address

Daytime Phone Number
*
(We will call between 8:00 am and 5:00 pm, CST, Monday through Friday)

Department Needed
select departmentAllergy/ImmunologyAnesthesiologyBluhm Cardiovascular Institute of NorthwesternBone Health and Osteoporosis ProgramCancer Genetics ProgramCardiologyCardiothoracic SurgeryCognitive Neurology and Alzheimer's Disease Center (CNADC)DermatologyEmergency MedicineEndocrine SurgeryEndocrinology/MetabolismGastroenterologyGastrointestinal SurgeryGeneral Internal MedicineGeriatricsGynecologic OncologyGynecology and Gynecologic SurgeryHematology / OncologyHepatologyHIV CenterHospitalist ServiceImmunotherapyInfectious DiseaseLynn Sage Comprehensive Breast CenterMaternal-Fetal MedicineNational Ovarian Cancer Early Detection Program (NOCEDP)NephrologyNeurological SurgeryNeurologyNorthwestern Sinus and Allergy CenterObstetrics and Gynecology, GeneralOphthalmologyOrthopaedic SurgeryOtolaryngology Pain Medicine CenterPathologyPhysical & Occupational Therapy Plastic and Reconstructive SurgeryPsychiatry and Behavioral SciencesPsychiatry and LawPulmonary and Critical Care MedicineRadiation OncologyRadiologyRadiology: Interventional NeuroradiologyRadiology: Interventional RadiologyReproductive Endocrinology and InfertilityReproductive GeneticsReproductive Ultrasound (Obstetrics and Gynecology)RheumatologyRobert H. Lurie Comprehensive Cancer CenterSTAR Program (Comprehensive Care for Childhood Cancer Survivors)Surgical OncologyTransplantation SurgeryTrauma and Critical CareTravel Medicine and Immunization Center (TMIC)UrogynecologyUrologyVascular SurgeryWellness Institute

Have you ever been seen by a Faculty Foundation physician before?
Yes   No

Have you ever been seen by a physician in this department before?
Yes   No

If you are a returning patient, who is your doctor?

Comments

You must be 18 years of age or older to use and submit this form.