Speech Pathology Appointment Request Form

We are happy to schedule Speech Pathology appointments for new and returning patients via this online form. Please complete the below fields and submit. We will contact you within 1 business day to confirm your appointment.

For more information or to make an appointment by phone, please call 847-535-6762 

*required information
What is your preferred method of contact?*
Are you a new or returning patient?*
Type of Appointment*

Do you have a physician's order for this appointment?*
Which day(s) of the week would you prefer your appointment? (Check all that apply.)*

Which time(s) of the day would you prefer your appointment? (Check all that apply.)*

Which location(s) would you prefer? (Check all that apply.)*

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We offer a variety of appointment times to best fit our patients' busy schedules. Please call to determine the best appointment time for you.

Rehabilitative Services
Lake Forest