New Patients: Forms & Policies

If this is your first time with Heart of Illinois Obstetrics & Gynecology, you’ll need to fill out our new patient packet, which you can find by clicking HERE. Please print and fill out this packet prior to your appointment.

For Your First Appointment:

  • Print and complete the new patient packet.
  • Be prepared to provide insurance information and bring a current insurance card and valid I.D.
  • Should a conflict arise with your appointment, please call us if you are running late or if you cannot keep your appointment.
  • Please arrive 10-15 minutes before your appointment so we have enough time to make sure your intake forms, insurance and other paperwork are complete

Office Policies:

After hours & emergency care: For non-emergency calls after business hours, call (309) 454-3456 and follow the phone instructions. For emergency situations, dial 911.

Prescription renewals: Call our office to request a prescription refill. If you are calling after hours, your new prescription will be refilled on the following business day.

Office Payments: We request that all office visit charges and office procedures be paid at the time of service, unless you are covered by an insurance plan that we are currently enrolled in. We accept cash, checks, Discover card, Visa, & Mastercard credit cards.

Cancellations/No-Show: We ask that if you are unable to keep your scheduled appointment, please make every effort to contact our office at least 24 hours prior to the appointment date. In the event that you miss 3 or more appointments without cancelling, we may decide to discontinue your care with our office.

Insurance Information: Please be prepared to provide the information needed to verify your insurance coverage and file your insurance claim. Deductibles, co-insurance, and co-payments are due at the time that medical services are rendered.

Additional Forms (click to open):