Request Appointment

Please note that this form is for requesting appointments only. Availability will vary and someone from our office will call you within 24 business hours to book your appointment.
Please do not submit any Protected Health Information.

Day of the week you prefer(*)
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Time of day you prefer(*)
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Time of day you prefer(*)
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Time of day you prefer(*)
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Full Name(*)
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Email(*)
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Phone(*)
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How did you hear about us?
How did you hear about us?

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Referred by Doctor?
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Referred by?
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Referred by other?
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Describe nature of appointment

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Lifetime Health and Wellness

Location

Visit Us

101 South McLean Blvd., Suite A, South Elgin, IL 60177

Time

Hours in Operation

Monday and Wednesday: 9:00am - 7:00pm
Tuesday and Thursday: 3:00pm - 7:00pm
Friday: 9:00am - 12:00pm
Saturday: 8:00am - 11:00am
Closed for lunch daily from 12:30pm - 3:00pm

Phone

Call Us

(847) 717-3400

Fax

Fax Us

(847) 255-7945

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