New Patients
Interested in becoming a new patient?
Please give us a call at (309) 263-2411 and provide us with the following information: name, date of birth, insurance information, list of medications, conditions and/or any specialists who currently treat your medical conditions.
The providers will review this information and decide which provider would be most appropriate and beneficial for your healthcare needs.
Patient Forms
Health History - Adult (18+ years old)
Health History - Child (<18 years old)
Patient Registration
Medication Consent and Compliance Form
Privacy Practices (Information Only)
Privacy Practices (Signature Form)
Payment policy
HIPPA (Disclosure) Form
Release Consent Form
Health History - Child (<18 years old)
Patient Registration
Medication Consent and Compliance Form
Privacy Practices (Information Only)
Privacy Practices (Signature Form)
Payment policy
HIPPA (Disclosure) Form
Release Consent Form
ServicesCOVID-19 TESTING
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