Forms

Patient Information Forms
HIPAA Privacy Statement
Healthcare Power of Attorney
Release of Records to Primary Care Associates from Another Physician or Hospital
Release of Records from Primary Care Associates to Another Physician
Childhood Lead Risk Assessment Questionnaire
Tuberculosis Screening Questions
IHSA Sports Pre-participation Exam Form
Modified Checklist for Autism in Toddlers
Vanderbilt Teacher Follow-up Form for ADHD - Teacher's Form
Vanderbilt Parent Follow-up Form for ADHD - Parent's Form

Patient Education

Patient Portal
Telemedicine
Patient Forms
Map & Directions
Our Office

Announcements:

WE DO NOT HAVE THE COVID VACCINE: as of 12/18/20, immunizations are being given to healthcare workers at the hospital.
Only well patients are being seen inside of our office.
Patients with any acute illness (fever, sore throat, cough, cold, vomiting, diarrhea or other symptoms of illness) are being seen in their cars in our parking lot OR in our new sick bay with a back door entrance by appointment only. Call 708-775-5025 when you arrive to sign-in from your car.
Cook County Department of Public Health Covid-19 Vaccine Registration Form- click below
http://bit.ly/3rW8HxF

For more information about Covid-19, please see CDC.GOV (Centers for Disease Control and Prevention), llinois Department of Public Health (dph.illinois.gov) or call the Covi-19 Hotline at 1-800-889-3931.