CAHA Patient Visit Forms:

  • M-CHAT-R (Modified Checklist for Autism in Toddlers- For the 18 month and 2 year well-child visits)
     
  • Daycare Letter- Explains the use of the NEW 2017/2018 DHS School Form with new logo. You may attach this letter to your computer generated school form and give it the school/daycare if they questions the validitiy of the form.

  • Patient Screening Questions- All Visits

  • IHSA Pre-participation Examination (Illinois SPORTS form)

Preparing for Your Visit as a NEW Patient

  • To expedite your appointment, please bring a copy of your child's medical records.  You can print and fill out the Patient Registration and Patient Financial Policy forms and bring them with you to your first visit.

              In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

Patient Registration Form

Patient Financial Policy

  • To have medical records released from a previous doctor and sent directly to CAHA, please fill out the "Release of Records" form and send it to your previous doctor.

Authorization for Release of Records Form

  • Please bring the address and phone number of your preferred pharmacy so we can electronically send your future prescriptions.

  • If you have a baby younger than 1 year of age, we suggest you bring a small blanket in case your baby is cold while undressed.

  • Discuss what will happen at the visit with your children and prepare them for the possibility of getting shots.  Reading books about going to the doctor sometimes helps younger children know what to expect.