MedicsPremier - Patient Portal

New Patient

735 North Perryville Road
Lower Level #2
Rockford, IL 61107
(815) 398-1300

Summit Location:
3849 North Perryville Road
Rockford, IL, 61114
(815) 398-1300

Appointment Selection

Please note that your booking request is preliminary and is subject to office approval. Once your appointment has been approved you'll receive a confirmation e-mail. You may book up to 60 days in advance.

Exam Type: *

Appointment Type: *

Authorization/Certification Number:

Availability for 12/05/2023

Open appointment times within 4 hours of the current time are not shown. Please call the office if you require immediate availability.

Please make a selection above.

Fields marked with a (*) are required.

Patient Profile

Please type in your information below.

First Name: *

Middle Name:

Last Name: *

Date of Birth: *

Sex: *

Home Phone Number: *

Mobile Phone Number:

Street Address: *

Apt/Suite/Other:

City: *

State: *

Zip Code: *

Fields marked with a (*) are required.

Online Account

Please select a username for your online patient portal account below.

Username: *

E-Mail: *

Password: *

Confirm Password: *

Passwords should be a minimum of eight (8) characters.

Fields marked with a (*) are required.