New Patients / Forms

We understand that navigating the changing landscape of health care, insurance payments and deductibles, and prescription medication is very complicated, stressful, and at times confusing. Please call us if you have questions about your insurance, medications, or services.

New Patients

Please bring the following to your appointment:

  1. Insurance card
  2. Government issued ID
  3. Credit card
  4. Completed patient forms (see links below)

A valid insurance card and verification of identity is required for us to bill your insurance. A credit card is required and will be kept securely on file. Our office will only bill the credit card on file if there is a remaining balance after insurance has paid, a statement has been mailed to your address, and our office has attempted to reach you by phone regarding the outstanding unpaid balance.

All HMO plans require a referral from your PCP. Without a referral, we are not able to bill your insurance and you will have to pay in full on the date of service

Our list of accepted insurances is continuously evolving. Please call our office or your insurance company to confirm whether or not you’re in network with our office.

Accepted Insurance Providers:

  • Advocate (APP) Plans
  • AMITA Risk and Non-Risk Plans
  • Aetna PPO
    • Aetna Choice Plans
  • Blue Cross Blue Shield of Illinois
    • BCBS HMO
    • BCBS PPO
    • BCBS Medicare Advantage
  • Cigna
    • Cigna PPO
    • Cigna Choice Fund PPO
    • Cigna Advantage Medicare HMO
    • Cigna Open Access Plus
  • Clear Spring Health
  • First Health EPO & PPO
  • Humana
    • Humana Preferred PPO
    • Humana Medicare Advantage Plus
    • Humana Premier HMO
  • Multiplan
    • Multiplan PPO
    • Multiplan/Beech Street PPO
  • United HealthCare
    • United HealthCare Choice Plus PPO
    • United HealthCare Select HMO

Patient Forms

Please print and complete the following forms prior to your visit. Bring them with you to your appointment in order to make your check-in process quick and easy.

For your convenience, you may also download the forms, complete and save them, and email them to HELPDESK@DPGCHICAGO.COM.

Note: the Minor Patient Registration Packet is to be completed for patients 17-years-old and younger.

Please log onto our Patient Portal to complete your Patient Medical History Form. If you are unable to access the portal, contact our office or print and complete the paper version of the Patient Medical History Form.


Book an appointment at our Chicago, IL office online. To schedule by phone, call us at (773) 938-8128. Visit our Contact page for location, map, and hours.

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