Patient Forms

We know your hands are full when you get to the office.  Feel free to print some of your forms at home and bring them with you to your visit

General visit forms

New patients

Authorization for Release of Records: Please have your medical records faxed to us ahead of your appointment (312-943-6924).  You can print this form and send it to your previous doctor.

Notice of Privacy Practices


 We can fill out camp and school forms as long as your child has had a well visit in the last 12 months.  Please allow up to 5 business days to recieve completed forms.  You may also bring your printed forms with to your next scheduled appointment.  Give them to the nurse at the beginning of the visit and we will try to finish them before you leave.

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Contact Us

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Our Location

1030 N Clark Street, Suite 400 Chicago, IL 60610

Hours of Operation

Walk-in sick hours are Monday - Saturday from 8:30 - 11:30am.

Child & Adolescent Health Associates

Monday:

8:30 am-5:00 pm

Tuesday:

8:30 am-7:30 pm

Wednesday:

8:30 am-5:00 pm

Thursday:

8:30 am-7:30 pm

Friday:

8:30 am-5:00 pm

Saturday:

8:30 am-11:30 pm

Sunday:

Closed