New Patients:
Please complete both the New Patient Registration and New Patient Medical History forms. Once both completed forms are received, our office will contact you to schedule your first appointment. Please allow approximately 20 minutes to complete and have your Photo ID and Insurance card(s) available. Please note, we are currently scheduling new patient visits in 2-3 months.
To complete forms online:
New Patient Registration Forms (Complete Online)
New Patient Medical History (Complete Online)
If you prefer to print and complete your forms, please click below to download:
New Patient Registration Forms (Print)
New Patient Medical History (Print)
Accountable Care Organization (Medicare Patients Only)
Printed forms can be returned by:
Mail to: SSD Medical Group, 12151 Regency Parkway, Suite 12165, Huntley, IL 60142
Fax: 847-984-1915
E-mail: ssdmedical@myupdox.com
Existing Patients:
If you prefer to print and complete a log form, please click below to download: