Request an Appointment

• Name

  Name * First Last
• Date of Birth

  Date of Birth / MM / DD YYYY

  
• Preferred Phone Number

  Preferred Phone Number * - ### - ### ####
• Email *
• Please indicate the date that would be your first preference for an appointment. For same day appointments, please call the clinic at which you would like to be seen.

  Please indicate the date that would be your first preference for an appointment. For same day appointments, please call the clinic at which you would like to be seen. / MM / DD YYYY

  
• What time of day do you prefer?
  What time of day do you prefer?

  Morning Afternoon
• Are you a new patient?
  Are you a new patient?

  Yes No
• What type of blood disorder, cancer or other condition have you been diagnosed with?
• Preferred Clinic Location (see locations and addresses): *
  Chicago Ridge - Medical Oncology at Millennium Medical Center, First Floor Chicago Ridge - Medical Oncology at Millennium Medical Center, Second Floor Mokena - Radiation Oncology at Southland Oncology Hazel Crest - Radiation Oncology at South Suburban Cancer Center Orland Park - Medical Oncology at Great Lakes Medical Center Affiliated Oncologists at Silver Cross - New Lenox (Medical Oncology) Affiliated Oncologists at Hazel Crest (Oncology/Hematology) Affiliated Oncologists at High Tech Medical Park – Palos Heights (Radiation Oncology) Affiliated Oncologists at Advocate Christ Medical Center - Oak Lawn (Radiation Oncology) Affiliated Oncologists at OSF Little Company of Mary Hospital - Oak Lawn (Gynecologic Oncology) Affiliated Oncologists at Advocate Good Samaritan Hospital - Downers Grove (Gynecologic Oncology)
• Preferred Provider (see provider bios):
  Elke Aippersback, MD, MSC - Radiation Oncology Vasia Ahmed, MD - Medical Oncology Bassem Chaar, MD - Medical Oncology Paul Crossan, MD - Radiation Oncology Steven Engel, MD - Radiation Oncology Corey Foster, MD, MS - Radiation Oncology Alfred Guirguis, DO, MPH - Gynecologic Oncology Rami Haddad, MD, FACP - Medical Oncology Amar Hamad, MD - Medical Oncology M. Mufaddal Hamadeh, MD - Medical Oncology Shadi Hamdan, MD - Medical Oncology H. Jason Kang, MD - Radiation Oncology Mouhammed Kelta, MD - Medical Oncology Shadi Latta, MD - Medical Oncology M. Patrick Lowe, MD - Gynecologic Oncology Mahmoud Mahafzah, MD, PHD, FACP - Medical Oncology Abdullah Malas, MD - Medical Oncology Carrie McIlwain, MD, MPH - Gynecologic Oncology Ronald Myint, MD - Medical Oncology Nikki Neubauer, MD - Gynecologic Oncology Mauna Pandya, MD - Medical Oncology Jayanthi Ramadurai, MD - Medical Oncology Suby Rao, MD - Medical Oncology Shaina Rozell, MD, MPH - Medical Oncology Molly Roy, MD - Gynecologic Oncology Wasif Shirazi, MD - Medical Oncology Faisal Vali, MD - Radiation Oncology Harsha Varadhi, MD - Radiation Oncology Ghassan Zalzaleh, MD - Medical Oncology Usman Zaheer, DO - Medical Oncology
• How did you hear about us? *
  Physician Referral Google/Search engine Friend/Family Facebook Newspaper Billboard