317 E. Dundee Rd.
Palatine, IL 60074

Patient Information and Forms

What to bring to your first visit

Dr. Brezinski schedules a specific appointment time for your visit. Please provide 24 hours notice to change or cancel and appointment.
It is our policy to charge for missed appointments.

We do not double book appointments, so the time agreed upon is for you. If you for any reason you find you cannot make your appointment we ask that you call and tell us and we can reschedule you for a more appropriate time.

About Insurance

Dr. Brezinski accepts most insurance plans including Blue Cross/Blue Shield, United Healthcare, Humanna, and Medicare. This does not mean Dr. Brezinski is a preferred provider in your specific plan. We strongly advise all patients to check with their health insurance plan to see if Dr. Brezinski is a preferred provider with your insurance plan.

For Medicare patients:

The name, phone number and address of your primary care physician and the date of your last medical visit.

Complete forms Below

Our registration forms are available below.  Please download and complete  the information requested on the forms prior to your visit.  If you are unable to do this for any reason, please plan to arrive 20 minutes ahead of your scheduled appointment time to allow adequate time to complete the registration forms.  This also allows all of your scheduled appointment time to be available to meet with Dr. Brezinski.


Information gathering

First visits typically are information gathering.  Extra appointment time is scheduled for new patients to fully allow for explanation of your foot problem or issues, starting a treatment plan, answering your questions, and when possible, beginning treatment.

Bring medications list

Please bring a complete list of all medications, vitamins, or nutritional supplements you take including the dosage, frequency you take the products, and strength.

Consent for Care and Treatment Form
Medical History Form
Privacy Policy
Out of Network Benefits Form