Register Online

Patient E-registration


New Patient Forms Downloadable Forms

If you are new patient, please take time to download, print and fill out all the necessary forms prior to your visit. Link will open in a new window.

Download New Patient Forms

Permission To Treat Unaccompanied Minor Patient

Insurance Information

We accept most:

  • Medicare
  • HMO's: Sherman Choice, Health Select, McHenry County Physician Organization
  • Aetna
  • PHCS
  • HFN
  • Multiplan
  • Unicare
  • Blue Cross/Blue Shield
  • Humana
  • Cigna
  • United Healthcare

 

Please contact your insurance carrier to confirm whether Dr. Suleman Bangash is an In-Network provider.

If you have any further questions, please contact our billing office at (815) 455-7143. Our staff can help you with any further billing questions.

get Adobe Reader To view PDFs online you must have a PDF Reader installed. Install Adobe Reader