Patient Forms

The standard school form
for IL public schools.

Please allow 2-4 business days for our doctors to complete your forms. All sections designed to be filled out by parents/ guardians should be completed before you submit your forms for completion by our office.

Authorization Form Release of Health Information

To request that records from another doctor’s office be sent to our office, please use the authorization form above. Once the other office receives it, they can send us your child’s chart.

Authorization Form Request of Health Information

To authorize us to release your child’s records to another doctor’s office, please use the form above, and return it to our office.