top of page

NEW PATIENT
Appointment Request

*DO NOT use the form to communicate clinical matters, request new or changes in appointments, request for records, billing information or messages for your doctor or therapist. The email below is not encrypted, cannot be forwarded and is not always checked promptly enough to respond to clinical issues, so PLEASE CONTACT US DIRECTLY BY PHONE.*

To schedule an appointment or to obtain information about services at PRA, call one of the offices below.

Schaumburg

Vernon Hills

Crystal Lake

Patient Date of Birth
Month
Day
Year

Street Address, City, State, Zip Code

bottom of page