Consent to Medical Care

Consent to Medical Care

Thank you for seeking care from Northwestern Medicine, the integrated academic health system of Northwestern Memorial HealthCare, including hospitals and physicians (“NM”). This Consent to Medical Care Agreement authorizes NM to provide you medical care, share your health information and receive payment for the service provided.

Click these links for listings of all NM locations and physicians. Other than in the case of an emergency, you must sign this form prior to treatment. See sample consent form below.

Consent for Medical Care form

Consent for Medical Care form (Minors)

Consent for Medical Care form (Spanish)

If you have non-financial questions about the Universal Consent, please contact the Patient Relations Department at your affiliate. If you have financial questions, please contact Customer Service for questions about payment and insurance, and contact Financial Counseling for questions about Financial Assistance. Please Contact Us and request the Main Operator to transfer you to the appropriate department.