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NEW PATIENTS

New Patient Forms

Download and fill lout these forms before your first visit.

​Welcome to Dr. Scott Selby, LLC

 

Scheduling is by appointment only, so please contact me at dr.selby@mac.com or use the contact form below to request a visit.

 

1. Information Needed to Get Started

When you are ready to schedule your initial consultation, I’ll need the following information to begin your registration:

Demographic Information

  • Full legal name

  • Date of birth (MM/DD/YYYY)

  • Permanent home address

  • Preferred email address

  • Preferred mobile phone number

 

Insurance Information

  • A copy of the front and back of your primary insurance card

  • The name and date of birth of the primary cardholder (if not you)

 

Appointment Availability

  • Suggest days/times you are available

  • Note: Consultations are scheduled for 60–90 minutes
     

2. Download & Complete Intake Forms

Download and fill out the forms in advance:

  • You may complete them digitally or print out and complete by hand and scan as a PDF. Email as separate documents or print and bring the completed forms to your appointment

  • Please write your name on every page and sign where indicated.
     

3. Day of Your Appointment
  • When you arrive at The Grove, send me a text at 630-781-6697.

  • I’ll reply when I’m ready for you to enter my suite.

  • Please note: Suite 1071 does not have a reception area. You are welcome to wait in any of the common reception areas on the main floor if you arrive early

 

4. Directions to the Office

Dr. Scott Selby, LLC
The Grove Professional Office Complex
Building B, Suite 1071
2100 Manchester Road
Wheaton, IL 60187

Directions:

  • The Grove is just west of the DuPage County Fairgrounds and east of County Farm Rd.

  • Enter the lot and drive between Buildings B & C.

  • Park near the south side of Building B, at entrance marked 1000.

  • Inside, take the stairs or elevator to the 2nd floor.

  • Restrooms are at the top of the stairs/elevator.

  • Suite 1071 is down the hallway to the right.

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LOCATION

2100 Manchester Road,
Suite 1071
Wheaton IL 60187

 

Email: info@drscottselby.com

Tel: 630.781.6697

Business Hours:

Mon - Fri:
By Appointment Only

CONTACT

    © 2025 by Dr. Scott Selby LLC

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