Medical opinion request form

New cancer diagnosis? Seeking a second opinion? Our specialists help put you in control.
  1. Fill out our brief form.
  2. A nurse navigator or advanced practice provider will contact you for a telephone screening to determine eligibility within 24-48 hours or the Monday following a weekend request.
  3. Receive your medical opinion. Patient must be present for appointment, provide relevant medical records and insurance eligibility. Medical opinions will not be given over the phone.

*Indicates required information

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I am filling this out for:
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I would like to connect with a Cancer Center staff member concerning:
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Are you currently a patient with Edward-Elmhurst Health?
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Gender
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Is this request for the Edward Cancer Center in Naperville and Plainfield, or the Nancy W. Knowles Cancer Center in Elmhurst?
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How did you hear about the Edward-Elmhurst Health Cancer Centers?
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