For patients, families, and caregivers

Request primary care, wound care, or follow-up in Metro East Illinois.

Share basic contact, location, current setting, and care-need information. The Gateway care team will review the request and follow up to determine the next step.

Start the request Call 314-325-0126

BellevilleSt. Clair CountyMadison CountyMetro East Illinois

Request careMetro East care team

What happens next

A simple, human first step.

1Send basic contact, location, and setting details

2The regional team reviews the request

3Intake confirms fit, availability, and next steps

Emergency? Call 911 for severe bleeding, chest pain, difficulty breathing, sudden confusion, or another urgent or life-threatening symptom.

Patient and family request

Start with the basics so the team can route the request correctly.

This public form is for intake coordination. Do not include medical records, wound photographs, Social Security numbers, or detailed protected health information.

Leave blank

Your contact information

Your nameYour relationship to the patientPhoneEmail optionalPreferred contact methodBest time to reach you

Where care is needed

Patient city or ZIP codeCurrent care settingPrimary care relationshipMain type of help neededPreferred response timingBrief note Do not include detailed records or photographs

Privacy: This public form is for minimum intake information only. Call 314-325-0126 for the appropriate secure channel if records, photographs, or detailed protected health information are needed.

I understand this public form is for intake coordination and should not contain detailed medical records or wound photographs.

Call us: 314-325-0126