Patient Info

Directions

Located between Golf and Algonquin Roads in Arlington Heights, the office is easily accessible from Route I-90.
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Initial Visit

On your initial visit, please arrive 15 minutes before your scheduled appointment. You will need to provide us with a brief medical history that should include any medical conditions you have or may have had in the past. Your history will need to include the following:

  • surgical history
  • any medications – prescription or over the counter (Name, dosage and how often you take them)
  • allergies to medication or food
  • You will also need to bring any actual recent xrays (not reports) related to your condition, as well as any medical records from previous physicians you have seen or from a physician who is referring you to Northwest United Urology, LLC. In addition, if your insurance company requires that you bring a referral or have a referral number for your visits to specialists, you should contact your Primary Care Physician for your referral prior to your specialist visit with us.

    Patient Forms for New Patients

    As a new patient, you will find it extremely helpful to download the following forms, which Northwest United Urology, LLC physicians will need for your initial visit. Please complete these forms at home before your visit. If you do not understand any part of any of the forms, you can just leave it blank and complete it after you arrive at the office. The forms you will need to download for information and completion are:

    Additional Patient Forms

    Other forms that may be helpful to you are:

    Insurance

    The physicians at Northwest United Urology, LLC are credentialed with numerous insurance plans, including, but not limited to the following:

    • AARP
    • Aetna Healthcare
    • Beech Street
    • BLUE CROSS BLUE SHIELD
    • Cigna Healthcare
    • Coventry Healthcare
    • Great West
    • Health Dynamics PPO
    • Healthspring
    • HFN
    • Humana Healthcare
    • Medical Care Group
    • MEDICARE
    • Multiplan/PHCS
    • Preferred Network Access
    • Preferred Plan PPO
    • RAILROAD MEDICARE
    • Three Rivers Provider Network
    • United Healthcare

    Hospital and Affiliations

    Northwest Community Hospital
    800 W. Central Road
    Arlington Heights, IL 60005
    847.618.1000
    Alexian Brothers Medical Center
    800 W. Biesterfield Road
    Elk Grove, IL 60007
    847.437.5500
    St. Alexius Medical Center
    1555 Barrington Road
    Hoffman Estates, IL 60169
    847.843.2000
    Adventist Glen Oaks
    701 Winthrop Ave
    Glendale Heights, IL 60139

    Privacy Practices

    Northwest United Urology, LLC makes available to every patient a copy of our current Notice of Privacy Practices. Our office asks each patient to sign a Notice of Privacy Practices Acknowledgment (*pdf form), stating that he or she has read and is aware of our Notice of Privacy Practices.

    If a patient would like personal healthcare information released to anyone other than himself, Northwest United Urology, LLC provides a Patient Authorization Form (*pdf form). By using this form, patients may designate who, besides themselves, may receive information regarding their confidential medical information.

    Patients wishing to review their Northwest United Urology, LLC medical records may use the Patient Records Access Request Form (*pdf form) to request a review appointment. Chart reviews take place in our offices by appointment and with an Northwest United Urology, LLC representative present. If a patient wishes to amend his or her chart in any way, Northwest United Urology, LLC provides a Patient Request to Amend Records Form (*pdf form) for that purpose.

    For further privacy information, please call the Office Manager at 847.439.4343.

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