Nominate a Provider

If you would like to nominate a provider for consideration into the HealthLink network, please click on the links provided below based on the area where the provider's practice resides. Please note this nomination does not guarantee the nominated practitioner will become a participating provider of HealthLink. The contracting and credentialing process can take 90-120 days.

Electronic Forms
Manual Forms

For Northern Illinois provider nominations, please print out the below form for completion and fax it to 312-234-7430.

Download Adobe Acrobat Reader to view the various portable document format (PDF) documents available throughout the HealthLink website.