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Health Center Forms

If you are able to come to your appointment with the appropriate forms filled out you will save valuable time. Please call 773-298-3712 with any questions.

New Patient Forms

Please read our Consent to Treatment (PDF) carefully and then fill out:

Release of Information

  • Release of Information (PDF)
  • Complete this form if you need your health information sent to the »Ê¹Ú²ÊƱ Health Center or if you need the »Ê¹Ú²ÊƱ Health Center to send your health information to a third-party.
  • The completed form can be dropped off at the Health Center, faxed to 773-298-3906, emailed to healthcenterFREE»Ê¹Ú²ÊƱ or uploaded to our secure patient portal. Please allow two business days for processing.

»Ê¹Ú²ÊƱ Athlete Forms

Please see the »Ê¹Ú²ÊƱ Athlete Physical page for all information about athlete physicals, including all forms.

Travel Medicine