Download Patient Forms

  • HIPAA Pracitces Microsoft Word File - Click To Download
  • Pay Agreement Microsoft Word File - Click To Download
  • Personal Representative Microsoft Word File - Click To Download
  • Receipt Privacy Pracitces Microsoft Word File - Click To Download
  • HIPAA Pracitces PDF Acrobat File - Click To Download
  • Pay Agreement PDF Acrobat File - Click To Download
  • Personal Representative PDF Acrobat File - Click To Download
  • Receipt Privacy Pracitces PDF Acrobat File - Click To Download
  • We have provided these patient forms for your confience. Please feel free to download and print them off in your leisure. We had provided two separate formats for downloading. We have Microsoft Word Doc files for those of you that have Microsoft Office Software on your computer/laptop, or Adobe Acrobat PDF files for those of you who don't have Microsoft Office but have Adobe Acrobat Reader. If you have neither of these you can download the software to print out either Doc or PDF files, Microsoft Word Viewer or Adobe Acrobat Reader. If you wish to just file out these files at the office, we have this paperwork available for you upon your arrival.

    Our Office Location

    107 N Regency Dr. Ste. 3
    Bloomington, IL. 61701

    ph #: 309.661.0406
    fax #: 309.661.6446

    Our Office Hours

    Monday - Friday • 8:00am - 4:00pm
    Saturday & Sunday • Closed

    After Hours Emergency
    ph # 877.279.2668

    Our Patient Portal