Online Appointment Request

Request a Prompt Appointment

Complete our secure, online appointment request form below and an MHS staff member will respond to your request as quickly as possible. Your information is always held in strict privacy. If you would rather speak to one of our representatives directly, please call 630-359-6888, and we will schedule an appointment at the MHS office nearest you.

* Indicates required fields.

Midwest Hand Surgery Appointment Request
Name: *
First Name Last Name
Address:
Street Address 1 Street Address 2
City State / Province
Postal / Zip Code
Phone Number * Email
Reason for visit:
Insurance Carrier Referring Physician
Is your injury/condition work related? *
  • Yes
  • No
Please request your appointment time below
Doctor * Desired date *
Pick a date
Please choose your desired location *
  • Elmhurst
  • Palos Heights
  • Lockport