The physicians and staff of Lake County Surgeons welcome you. Serving new patients requires some background information regarding your medical history and establishing your permission. Please take a moment to download, print and complete these forms and then bring them with you for your appointment.

New Patient Form

MS Word : 22kb

Medical History Form

MS Word : 22kb

Patient Authorization Form

MS Word : 25kb

Privacy Acknowledgement

MS Word : 22kb

Please feel free to contact our staff should you have any questions during the completion of the forms. We can be reached at 847-816-1966 and 847-856-2525. Our offices are very easy to find. Click here for maps to our two locations

Please join Dr. Siegel and Dr. Gibson for a free seminar about the latest techniques in medical weight loss proceedures.