Complete the following information and provide it to us via email (firstname.lastname@example.org) or by phone (815-893-0439) so insurance coverage can be verified prior to your first visit. You will receive a phone call detailing what your insurance will pay for services.
CASH clients may skip to STEP 2.
|2019 Patient Registration and HIPAA Forms (pdf)||Download|
Bring the completed and signed forms with you on your first visit. We also appreciate any pertinent medical records, X-rays, and MRI’s you may have. Also bring a list of your current medications.