First Visit

Welcome to our office. Thank you for choosing UrbanCare for your healthcare needs. We look forward to meeting you!

The checklist below will help you prepare for your first visit:

For my first visit, I need to:

  • Check-in 15 minutes prior to appointment time.
  • Bring Insurance Card
  • Bring Driver's License or Picture ID
  • Bring any referrals and/or medical records that are required for your visit.
  • Bring credit card / checkbook / cash. Co-pays and charges not covered by insurance are due on the date of service.

Click on any Patient Form icon below to download an Adobe Reader® file of that form. Print, fill out and bring them with you to your first appointment.

get adobe readerIf you don’t have Adobe Reader on your computer, click here for a free download:

Patient Registration Form
Patient Registration
Medical History Form
Medical History
Request for Confidential Communication
Request for Confidential Communication
Financial Policy
Financial Policy
Privacy Policy
Notice of Privacy Practices
 


MapUrbanCare, LLC
170 N. Lakewood Road
Lake in the Hills, Illinois 60156
phone 224-569-4000
fax 224-569-4001