Visit Check-In

Visit Check-In
Welcome! You may now check in for in-office and carside visits here.

Caseyville: for outside visit, park in a numbered space if possible.

Bethalto: for outside visit, pull into the Ambulance Entrance.
Patient Name*
Office Location?*
I am in:*

Waiting Room (Patient Appointment)Waiting Room (No appt., here to see STAFF only)Spot 1 (Caseyville)Spot 2 (Caseyville)Spot 3 (Caseyville)Spot 4 (Caseyville)Spot 5 (Caseyville)Spot 6 (Caseyville)Spot 7 (Caseyville)Spot 8 (Caseyville)Other Spot (Caseyville, please call 618-345-5437 and tell us where you are)Ambulance Entrance (Bethalto, please describe your vehicle below)
If NOT in numbered slot, please tell us where you are and vehicle make/model
Co-pays are due at the time of service. How would you like to pay today? *
Credit card# & exp. date:
Please enter card # and exp. date above and sign below.
Name on Card

First NameLast Name
Signature

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Should be Empty: