Joliet

903 N 129th Infantry Drive, Suite 400 | Joliet, Illinois, 60435
Phone: (815) 725-2653 | Fax: (815) 744-3232
Office Hours:
Monday – Friday | 9:00am – 4:30pm
24-Hour Answering Service Available

New Lenox

1890 Silver Cross Boulevard | Pavilion A, Suite 535 | New Lenox, Illinois, 60451
Phone: (815) 740-1301 | Fax: (815) 723-6778
Office Hours:
Monday – Friday | 9:00am – 4:30pm
24-Hour Answering Service Available

Midwest Sleep Disorders Center

903 N 129th Infantry Drive, Suite 300 | Joliet, Illinois, 60435
Phone: (815) 207-6106 | Fax: (815) 207-6107
Office Hours:
Mon, Tues, Wed, and Friday from 9:00am to 4:30pm
Thursday 9:30am to 5:00pm

Patient Portal Login

Request an Appointment

Note: This form is provided for your convenience. Information submitted here is not secured and may be accessible to unauthorized third parties. If you are concerned about privacy, we recommend that you request your appointment by calling our office directly.

First Name*
Last Name*
Phone
Email*
Type of Visit
For
Referring Physician
Provider Preference
Preferred Time/Day of Appointment
Location Preference

Rx Refill Request

Please complete and submit the information below to request a prescriptoin refill from your doctor. Refill requests are processed Monday thru Friday 9 am to 4 pm. Please allow at least 48 hours per request. If you need an urgent refill, we ask that you call our office directly.

Note: This form is provided for your convenience. Information submitted here is not secured and may be accessible to unauthorized third parties. If you are concerned about privacy, we recommend that you request your refill by calling our office directly.

Name*
Email*
Phone*
Date of Birth (mm/dd/yyyy)*
Doctor's Office Location*
Medication Name*
Pharmacy Name*
Pharmacy Phone*