top of page

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.

office-2.jpg
office-3.jpg

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

    bottom of page