Welcome to Pronger Smith Medical Care

Online Appointment Request
Please complete the form below to submit a request for an appointment. After you submit a request, you will receive a call from a representative at the selected location within two business days to confirm your information and schedule the appointment.

If you require a more immediate appointment for an illness, call the primary care center directly. If you require a more immediate appointment for an illness, call the medical care center directly at 708 388-5500 (Blue Island) or 708 226-7000 (Tinley Park)

If this is an emergency, please call 911 immediately.

* = required fields Patient name:
*	Last name:
	Middle initial:
*	First name:
*	Gender:
*	Birth date: (mm/dd/yyyy)
*	Street address:
	Apartment,Unit:
*	City:
*	State:
*	ZIP code:
*	Primary phone: (xxx-xxx-xxxx)
	Alternate phone: (xxx-xxx-xxxx)
*	Best time to reach you at your primary phone #:
	E-mail address:
Contact person (if different from patient):
	Name:
	Primary phone: (xxx-xxx-xxxx)
	Alternate phone: (xxx-xxx-xxxx)
	Best time to reach you:
Appointment details:
*	Please select a medical care site:
*	Reason for appointment:
	If Other Please Provide Reason:
	Requested physician: For Additional Information, please refer to our Physician Biography Page.
*	Have you seen this physician before?:
*	Have you been to Pronger Smith MedicalCare within the last year?, If not: To expedite your visit complete the Patient information card and submit it via email or bring it with you on your next visit. Adult Form l Child Form

Indicate preferred date and time of the appointment:
*	Preferred appointment day:
*	Preferred appointment time:

In order to provide the best care possible, if you are uncomfortable with or cannot speak or understand English well, please ask a trusted English speaking family member to accompany you.