To request more information about MO-IBJI or if you would like someone to call you, complete the form below. Your request will be directed to the appropriate person and will be handled promptly.

First Name:	Last Name:

Street Address:

City:	State:	Postal Code:

Phone:

Type of request: (one required) Request a return phone call. Request information to be mailed.

Other comments or requests

OFFICE HOURS/SCHEDULING APPOINTMENTS

Please print out the Patient Registration Form and fill it out before coming for your scheduled visit. Please download Acrobat Reader to view the file.

The offices are open from 8:30 a.m. to 5:00 p.m., Monday through Friday. Appointments can be made by phone during business hours. Emergency evaluation and care are available if needed. We make every effort to see patients as promptly as possible. To assist us, please arrive 15 minutes prior to your scheduled appointment time. At times, unusual circumstances such as surgery schedule changes or patient emergencies may cause delays. We appreciate your patience when these occur.

If you are unable to keep your appointment please notify the office at least 24 hours prior to your scheduled appointment. This enables us to offer the appointment time to other patients.

WHAT TO BRING TO AN APPOINTMENT Previous x-rays and test results relating to your injury/illness Previous medical records relating to your injury/illness Your valid insurance card(s) Referral letters from your employer/primary care physician (i.e. workers compensation statement, HMO/PPO referals) Interpreter if needed Please wear attire that is comfortable during your examination

FOLLOW-UP

Any neccessary return visit or surgery will be scheduled by the secretary. This individual will provide you with the information you need and will make any neccessary arrangements. Informed consent concerning surgery will be obtained by your orthopaedist or the nurse practitioner.

Following your office visit, the physician will prepare an evaluation of your injury or illness, if appropriate. Medical reports and test results will be forwarded to your referring physician and/or employer in a timely manner. Special test resuts will also be scheduled through the secretary.

If prescription refills are needed, please contact the office during our regular business hours.

IF YOU HAVE AN EMERGENCY

After hours, all calls to the office are forwarded to an answering service. In the event of an emergency, please inform the operator that immediate assistance is required. You will either be directed to your physician or be contacted by our "on call" doctor.

Main Office phone: 312-726-7846	North Lake Shore 4640 North Marine Drive 8th Floor-Elevator C Chicago, Illinois 60640 773.564.5887	Broadway 2860 North Broadway Suite 202 Chicago, Illinois 60657 773.327.8300
Chicago-East Loop/ Michigan Avenue 150 North Michigan Avenue Suite 1400 Chicago, Illinois 60601 312.444.1145	Chicago-Archer Avenue 6858 West Archer Avenue Chicago, Illinois 60638 773.229.1418	Foster Office 2740 West Foster Avenue Chicago, Illinois 60625 773.561.2600

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© 2003-2004 Midwest Orthopaedics, a division of Illinois Bone and Joint Institute. All rights reserved.