(847) 294-6722
1070 E. Oakton Street
Des Plaines, IL  60018


Appointment Forms
All patients will be given the these two forms when arriving at each visit so we can update our electronic medical records as we know things change from year to year.  Feel free to complete these and bring them in to your appointment to save you time after checking in.

1) Welcome / Entrance Form


2) Medical History Form

The following is our Notice of Privacy Policies for your review. There is a space for you to initial on our Welcome/Entrance Form indicating you were offered an opportunity to review our policy.  Although it is no longer necessary to sign and bring this form in with you, feel free to print a copy if you choose.

3) HIPAA Privacy Notice

 

   
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