New Pediatric Patients
Thank you for choosing Pediatric Associates as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease. We've included helpful items on this page to ensure you and your child's first trip to our office is productive, stress-free and enjoyable.
Our Mission
We at Pediatric Associates are committed to providing excellent medical care for our patients. Founded in 1987, our skilled team of pediatricians, nurse practitioners, nurses and medical office staff are here for you and your child from birth to 21 years of age. We offer comprehensive healthcare from routine well-child exams to acute care. Our goal is to develop an on-going relationship with you and your family, in a comfortable, caring environment.
We are here to listen to your needs and concerns and strive to provide the best pediatric healthcare for your family in a manner that is convenient to today's busy lifestyles. Our mission is to promote health maintenance, safety and wellness to our patients in a calm and caring atmosphere.
If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information when you arrive for your visit:
- Insurance cards
- Complete immunization records
- Medical records from your previous provider
Patient Forms
We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.
Please print forms prior to visit to expedite the check-in process:
New Patient Forms
- Authorization for transferring your medical records to us
- Authorization for transferring your medical records to another provider
- Statement of Financial Policy
- Authorization for Non-Parent Form
- HIPPA Privacy Act
ADHD
Asthma
Physical Exam 0-60 months
- Illinois Certificate of Child Health Examination Form (all ages)
- Physical Activity, Screen Time, and Nutrition Assessment (2 years and up)
- Lead Questionnaire (9 mos-6 years old)
- TB Questionnaire (6 mos and up)
- 6 Month Developmental Questionnaire
- 12 Month Development Questionnaire
- 18 Month and 24 Month M-CHAT
- 36 Month Developmental Questionnaire
- 48 Month Developmental Questionnaire
- 60 Month Developmental Questionnaire
Physical Exam 6 years old and older
- Illinois Certificate of Child Health Examination Form (all ages)
- Physical Activity, Screen Time, and Nutrition Assessment (2 years and up)
- Lead Questionnaire (9 mos-6 years old)
- TB Questionnaire (6 mos and up)
Physical Exam 11 years and older
- Illinois Certificate of Child Health Examination Form (all ages)
- Physical Activity, Screen Time, and Nutrition Assessment (2 years and up)
- IHSA Physical Form
- Depression Scale for Parents
- Depression Scale for Teens
- TB Questionnaire (6 mos and up)
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
Accepted Insurance
| Aetna US Healthcare | EPO, HMO, PPO, POS, NAP, ASA |
| Beach Street | PPO |
| Blue Advantage HMO-Site #331 | |
| Blue Cross/Blue Shield | EPO, PPO |
| Choice Care Humana Employers Health | |
| Cigna | PPO, EPO, HMO, POS, Open Access, Plus |
| Coventry/First Health | |
| Evolutions | |
| Great West PPO | |
| Healthlink | PPO |
| HFN PPO/EPO | |
| HMO IL SITE #331 | |
| Humana | PPO, POS, HMO, National HMO |
| Multi Plan | PPO |
| Preferred Health Network | |
| One Health Plan | PPO, HMO, Open Acess HMO |
| Preferred Health Network | |
| Preferred Network Access (PNA) | PPO |
| Private Health Care System (PHCS) | PPO |
| Tri-Care | Standard, Prime |
| Unicare | PPO |
| United HealthCare | HMO, EPO, POS, PPO, Choice, Select, Plus, Core |
|
USA Managed Care |
PPO |
**Insurance affiliations are subject to change. Please call the office for verification or questions.
Directions
Directions to 260 Congress Pkwy Suite B Crystal Lake, IL 60014 US
Please enter your zip code, city and state, or street address below for door-to-door directions.
Directions to 1435 N. Randall Rd Suite 408 Elgin, IL 60123
Please enter your zip code, city and state, or street address below for door-to-door directions.
Directions to 912 W. Northwest Highway Suite G-7 Fox River Grove, IL 60021
Please enter your zip code, city and state, or street address below for door-to-door directions.
What's New!
Our Barrington office has relocated!
As of January 1, 2012, the NEW address is:
River Pointe Professional Building
912 W. Northwest Highway
Suite G-7
Fox River Grove, IL 60021
(Phone numbers remain the same)
Quick Access
Sick Child?
Same day appointments!
847-381-6700
815-459-6780
Parent Resources
An online resource center providing you with additional helpful information.

