1170 E. Belvidere Rd. Suite #106
Grayslake, IL 60030

Phone: 847-548-7337

Fax: 847-548-9909

Call 847-548-7337

We offer same day appointments for sick patients. Check your child's symptoms here:

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Tour our office, meet our staff and ask questions regarding the birth of your baby.

 

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PATIENT PORTAL.


Registration Forms (For New Patients and Well Visit Appointments)

HIPAA (Health Insurance Portability and Accountability Act) Release Form / Spanish (Updated once a year)

Notice of Privacy

Financial Policy

Patient Information

Medical Records Release (To our office)

Well Visit Questionnaires and Forms

 

 

Miscellaneous Forms

State of Illinois School Physical Form / Spanish (Required for kindergarten, 6th grade, and 9th grade and upon entering a new school or daycare)

IHSA Sports Physical Form (If requested by school upon joining a sports team)

Asthma Control Test (ACT) 4-11 Years / Spanish, Asthma Control Test (ACT) 12-21 Years / Spanish (Required at least once a year for asthma follow up appointments and/or for children diagnosed with asthma coming for a well visit appointment)

Vanderbilt Assessment Scale - Parent and Teacher Forms (Need at least two parent and two teacher forms required for ADD/ADHD initial evaluation appointments)

Medical Records Release (From our office)