Health Forms

Fill out this form online to save time during your first visit.

  • Please enter your email, so we can follow up with you.
    **If you traveled to any of the states listed on the current Chicago Emergency Travel Order as a state experiencing a surge in new COVID-19 cases, we would ask you to reschedule your appointment at least 14 days after your return date.
  • This field is for validation purposes and should be left unchanged.