Referral Forms

Thank you for referring your patient to Illinois Cancer Specialists. Below are links to our Referral Forms by location. Please download, print, fill out and have your patient bring this to their first appointment.

Arlington Heights

Chicago

Crystal Lake

Elgin

Hoffman Estates

Niles

Axumin PET Scan Request

Patients referred to undergo Axumin PET/CT scans will have their scans completed within 1-4 business days following the receipt of the request form.

AXUMIN PET Scan Request Form

Our Only Care is You.

When you refer your patient to Illinois Cancer Specialists, you can expect compassionate, personalized care from a staff dedicated to providing the best and most advanced diagnostic and treatment services your patients with cancer or disorders of the blood.  Our practice of skilled physicians offers a consultative, multi-specialty team approach.  While our focus is on the patient, we understand the importance of keeping you, the referring physician, up-to-date on your patient's progress and treatment.

Illinois Cancer Specialists is dedicated to finding new and better ways to treat cancer and blood disorders through research and clinical trials.  As a member of the US Oncology Research Network, we participate in one of the most extensive clinical trial programs in the nation.  At any given time, we have more than 30 clinical research trials open for enrollment.  The US Oncology Research Network has played a role in the development of 60 drugs approved for the Food and Drug Administration.

We offer to referring physicians:

• Quick access, every effort will be made to see your patient within 48 hours
• 21 board-certified physicians
• 6 sites of service
• Medical Oncology, Hematology, and Radiation Oncology
• Lab and diagnostic results
• Diagnosis and treatment plan updates
• Physician consultations

If you need more information about our clinical trials program or if you have a patient who might meet eligibility requirements for a specific research study, please see our Clinical Research & Trials section.

Our staff also includes Practice Liaisons to help facilitate the referral process. For more information on our Practice Liaisons, contact us at one of our locations.