SportsMed - Wheaton Orthopaedics Ltd.

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Patient Information

 

What to Bring to Your Appointment

 

  • Your insurance card
  • A picture ID
  • Physician referral forms, if required by insurance
  • List of prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about your medical and surgical history
  • Recent x-rays or relevant records

Forms for Your First Appointment

To ensure a smooth and speedy check-in for your visit, please complete the following forms. Be sure to bring the completed forms and your insurance cards with you to your visit. If you have any questions, feel free to call us at 630.665.9155. Our patient service representatives are available by telephone Monday through Friday, from 8:00 a.m. until 4:00 p.m.

[PDF Help]

 

  • Patient Information Form [PDF]
    This form provides your current address and insurance information, gives SportsMed permission to bill your insurance, and asks for your permission and options as to where SportsMed can leave a confidential message for you. [PDF]
     
  • Please read our Financial Policy. [PDF]
     
  • Please read our Privacy Policy. [PDF]
     
  • Out of Network Waiver form [PDF]
    This must be signed only if you have an out-of-network policy.

     

 

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Financial Policy

SportsMed-Wheaton Orthopaedics's financial policy concerning billing and insurance is always available to patients.

 

  • Financial Policy
    This document states SportsMed-Wheaton Orthopaedics' financial policy concerning billing and insurance.

 

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Privacy Policy

SportsMed-Wheaton Orthopaedics' privacy policy concerning the use and disclosure of patient medical information adheres to all state and federal laws. The policy is always available to patients and is found below.

 

  • Privacy Policy
    This document state's SportsMed-Wheaton Orthopaedics' privacy policy concerning the use and disclosure of your medical information.

     

 

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Medical Record Release

SportsMed-Wheaton Orthopaedics will release your medical information to anyone you choose.

Complete the form below to allow the release of your medical information.

 

  • Medical Record Release form
    Complete and send this form to SportsMed-Wheaton Orthopaedics to allow release of your medical information to other s.

 

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Disability Forms Request

SportsMed-Wheaton Orthopaedics can provide patient forms to qualify for handicap parking, disabilty and family medical leave (FMLA). Complete the form below to request the disability forms you require.

 

  • Disability Forms Request
    Complete and send this form to SportsMed-Wheaton Orthopaedics to request handicap parking, disability and family medical leave (FMLA) forms.

 

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Surgery Forms & Information

The forms below provide information concerning post-operative care, joint replacement scheduling, each doctor's surgery schedule and EMMI. Be sure to review all relevant information if you are planning surgery.

 

 

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Insurance and Payment Information

We are providers for Medicare and most major insurance plans, and our office provides insurance billing for our patients. You are responsible for charges that are not covered by your insurance at the time of your appointment.

Your insurance company may require a co-payment at the time of your appointment. When necessary, our staff will work with patients to set up a payment plan.

If you have questions regarding billing or which insurance plans we accept, please call us at the phone number below. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

 

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Hospital/Surgery Center Affiliations

We are affiliated with the following hospital/ambulatory surgical centers:

 

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Refer a Friend

Flame SportsMed - Wheaton Orthopaedics Ltd.
327 Gundersen Drive
Suite A
Carol Stream, IL 60188
Tel: 630.665.9155
Fax: 630.665.8371
view map
636 Raymond Drive
Suite 104
Naperville, IL 60563
Tel: 630.355.2702
Fax: 630.355.4089
view map

2001 N. Gary Avenue
Suite 110
Wheaton, IL 60187
Tel: 630.665.9155
Fax: 630.665.8371
view map

Hospital/Surgical Center Affiliations