- The Wellness Center
- Buffalo Grove Fitness Center

HealthConnection:

Request an Appointment

Need a doctor appointment but don't have the time to call and coordinate your schedule? HealthConnection is here for you.

Please use our Online Physician Directory to locate the doctor you would like to see, and HealthConnection will do the rest. Your personal information will be held in strict confidence. In addition to finding an appointment day and time that meets your needs, we also will ensure that the physician you see accepts your medical insurance and meets your personal preferences.

To request an appointment with a physician on staff at Northwest Community Hospital, please complete this form. All fields are required. You will receive a confirmation phone call from HealthConnection. For further information, call HealthConnection at 847.618.4YOU Monday through Friday, 8:30 am to 4:30 pm.
Mr. Mrs. Ms.
Last Name	First Name	Birth Date(dd/mm/yy)
Address	City	State
Zip Code	Daytime Phone	Email Address

My Appointment Preferences:
Physician Last Name	Physician First Name	Physician Specialty

Preferred Appointment Day of the Week Monday Tuesday Wednesday Thursday Friday Saturday	Preferred Appointment Time Early Morning Late Morning Early Afternoon Late Afternoon Evening	New Patient? Yes No My Primary Health Insurance General Reason for Appointment (ie, pregnancy, annual exam, injury, sickness)

Last Updated on 01/10/07