Request a Referral

Do You Need a Referral?
If you have Blue Choice, Aetna PPO, Primary Select (BCBS), CCN Elect, Unicare, or Northwestern Healthcare, you need a referral for any medical care which is given out of the Town and Country Pediatric office.

These insurance companies require notification and a paper trail of your non-primary care visits.

General Referral Information
Your first step is to make the appointment. When you have an appointment date, you can call us or Fax us your request for a referral. You will need the following information:

• Patient's name and date of birth
• Your primary care doctor's name
• Your insurance carrier
• The specialist's name, address, and phone or Fax number
• The appointment date
• The diagnosis (if known)
• The reason for the visit
• Your name and phone number

For Halsted Patients:
If you wish to phone in the referral request, choose option #3 from our main menu option which will take you to the voice mail box for referrals. Leave all of the information listed above on the voice mail box. If you wish to Fax the referral request, click here for a referral request form. Fill it out and fax it to 312-981-6312.

For Glenview Patients:
Call 847-998-8806 and have the above information ready to give to the receptionist or click here for a referral request form and fax it to 847-998-8807.

For Lincoln Patients:
Call 773-478-1067 and have the above information ready to give to the receptionist or click here for a referral request form and fax it to 773-478-4916.

Your referral will be completed and faxed to your specialist on the day it is requested, Monday through Friday. Requests which come in on the weekend will be sent on Monday. A copy of the referral will be mailed to you.