Contact Us

Chicago Office 680 North Lake Shore Drive Suite 930 Chicago, IL 60611 Telephone: (312) 932-9900 Directions

Northbrook Office 1535 Lake Cook Road Suite 201 Northbrook, IL 60062 Telephone: (847) 291-3200 FAX: (847) 562-0670 Directions

Click here for a list of substances to avoid prior to surgery.

You can fill out the following forms or email us at drsweis@northshoresurgery.com.   We will be in contact with you.

Medical Questionnaire
Financial Policy
Hippa Form

*required

Name*:
Address:
City:
State:	Zip:
Phone Number*:
Email*:
Procedure you would like to discuss:	-- Select One -- Botox Cosmetic Soft Tissue Fillers Facelift Neck Liposuction Eyelid Lift Brow Lift Nose Surgery Chin Implant Ear Surgery Breast Augmentation Breast Reduction Breast Reduction (Men) Liposculpture Tummy Tuck Arm Lift Labial Reduction Inverted Nipples Skin Care Laser Hair Removal Aesthera PPX
Please let us know which day(s) are most convenient for you:	Monday Tuesday Wednesday Thursday Friday
If this is a procedure that is covered by insurance, please let us know which insurance you carry:
If this is a procedure which is not normally covered by insurance would you like us to mail you information about financing?	Yes No
Would you like us to mail you more information on the procedure itself?	Yes No
How did you hear about Dr. Sweis?
Comments or Questions:
If for any reason you are unable to keep your appointment, it is important to us that you let us know as soon as possible. We will be happy to reschedule you and offer that time to another patient.