New Patient Electronic Appointment Request

When you choose a physician on the medical staff at Northwestern Medicine, you will be selecting a professional from one of the nation's top healthcare organizations where patients come first. Northwestern Medicine's Physician Referral Service can act as your "front door" by helping you find a primary care physician or specialist for you and your family.

If you need an appointment with a physician you have not seen before, you may contact a Referral Specialist via an online form to request your appointment. Please read the confidentiality notice below and then click on the continue button.

Confidentiality Notice

The appointment request form requires you to answer confidential health information that is needed to complete your request and shall be utilized only for the purpose of helping you secure an office visit. By reading the Confidentiality Notice and providing the required health information, you consent to disclose confidential health information to a Northwestern Medicine affiliated physician. You also acknowledge the risk of sending your information via this website and agree to not hold Northwestern Medicine or any of its affiliates, employees or agents liable for any damages you may incur as a result of the transmittal of your information.