Patient Info Directions Initial Visit Patient Forms for New Patients Insurance Hospital and Affiliations Privacy Practices Ask Your Query Directions Located between Golf and Algonquin Roads in Arlington Heights, the office is easily accessible from Route I-90. Get Drivinng Directions 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. Northwest United Urology, LLC Northwest United Urology, LLC Northwest United Urology, LLC Northwest United Urology, LLC Northwest United Urology, LLC Northwest United Urology, LLC 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: Patient Welcome Letter New Patient Information and History Forms Medical Information Waiver Additional Patient Forms Other forms that may be helpful to you are: Notice of Privacy Practices Acknowledgment Patient Financial Responsibility 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. Ask Your Query * Fields are Mandatory.