Need a Doctor?

Call our Physician Referral Service at (815) 971-DRDR and one of our Physician Referral Specialists will help you find a doctor who's just right for you.
Request an Appointment

This form is not to be used in case of an emergency. If this is an emergency, please call 911 or your local emergency services provider.

To request an appointment as a new Rockford Health System patient, please complete the form below and one of our Physician Referral Specialists will contact you within 24 hours with information.  If you submit your request on a holiday or during the weekend, we will respond by the end of the next business day.  Our regular business hours are 8:30 a.m. to 4:30 p.m. Monday through Friday. 

Please note that this online appointment request feature is for first-time patients only.  If you are already established with one of our physicians, please contact the office directly.

To speak with a Physician Referral Specialist, call (815) 971-DRDR.


Patient Information
* Last Name
* First Name
* Date of Birth
* Street Address
* City
* U.S. State
* U.S. Zip Code
* Gender
* Current Insurance
Contact Information
* Email Address
* Daytime Phone
(###-###-####) 		Ext.
* Best time to call (Central Time Zone)
Appointment Information
* Type of Physician Needed
* Location needed
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