Request an Appointment

If you would like to schedule an appointment for a test or procedure at the hospital, fill out our online form here or call (773) 488-STBH (7824).

If you need urgent medical attention, call 911 or come to our emergency room at 326 W. 64th St., Chicago, IL, 60621.

First name (required):

Middle name:

Last name (required):

If patient is under 18, parent or guardian’s name:

Relationship to patient:

Date of birth (DD/MM/YYYY) (required):

Gender (required):

Mailing address (required):

City (required):

State (required):

ZIP code (required):

Phone number (required):

Other phone number:

Email address (required):

Reason for visit (required):

Preferred doctor:

Specialty needed:

New or existing patient (required):

Primary or referring doctor (required):

Insurance (required):

Financial assistance needed:

Additional comments: