Request an Appointment
Please do not use this form if you have an urgent medical problem or you need to reschedule an existing appointment. Instead, contact our office at (815) 477-7350. After you submit your request, our appointment scheduler will respond within 48 hours. See below for forms to complete. Established patients should log in to the patient portal to request appointments and update forms.
Patient Registration Forms
Northwest Pulmonary and Sleep Medicine and The Pulmonary and Sleep Institute in Algonquin, Illinois, welcomes you to our practice. Once you have made your initial appointment, you may preregister by downloading, printing, and completing the forms below.
Please be sure to bring all forms with you to your first visit, along with any diagnostic films or other test results that may have been ordered or performed by another provider.
- New Patient Packet
- Consent for Verbal Release of Information
- Consent to Release / Request Medical Information
- Specially Protected Health Information Authorization
- Notification: Opting out of eEHX
- Medication List
- Financial Policy
- Notice of Privacy Practices
Please note: It may take a few moments to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat Reader for free by clicking on the icon below.