What to bring with you to your first visit:
Please bring your current insurance card to every visit.
- Your driver’s license or state I.D.
- Current Insurance Card
- Completed Registration Form
- Privacy Forms --- Signed
- Patient History Form
- Your child's immunization records and growth charts (if transferring from another practice)
- Patient Registration [PDF] [Online]
- Patient Medical History Form [PDF] [Online]
- Consent to Treat Form (Minor) [PDF] [Online]
- Notice of Privacy Practices (HIPPA) [PDF] [Online]
- State of Illinois Certificate of Child Health Examination [PDF] [Online]
Transfer Medical Records
For families transferring care from another practice, please complete the following medical record release to have your records transferred to our office.
In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.