top of page

Patient Forms/Office Policies

New Patient Documents

Print the new patient paperwork and complete prior to your appointment.  You will need to complete the new patient information form, the HIPAA privacy form and the health history form.  Bring completed forms with you to your first visit.

 

Be sure to bring your photo ID, insurance cards and list of current medications to your first visit. as well . 

Medical Records Release

If you need to obtain your medical records, complete the form to the left.  Be sure to complete the form entirly and indicate to whom the records are being sent. Please note, if the records are being sent anywhere other than another medical office or facility, a fee may apply for the release of the records. To inquire more about medical record fees, please call our Business Office at 847/255-7226.

​

Once completed, mail or fax the form to our office. Please allow up to 2 weeks for the medical records to be sent. 

bottom of page