Welcome to Quintessential Care. To maximize your time with us, please download and complete the forms below and bring these papers with your health insurance card and government-issued photo ID to your initial visit.
If your paperwork is done, please plan to arrive 30 minutes before your scheduled appointment time.
If you are unable to complete your paperwork prior to your appointment, please arrive 60 minutes before your scheduled appointment time in order to complete these forms. Please contact us at (312) 598-3520 if you have any questions.
Download Full Set of New Patient Forms
Download individual forms:
- New Patient Intake Form
- Patient Registration Form
- Privacy Practices
- Financial Agreement Form
- Request For and Authorization to Release Health Information Form
Note
All our forms are provided in Portable Document Format (PDF). To view and utilize a PDF file (
) you may need to download the free Adobe Reader software.
Portable Document Format (PDF) is a file format used to present and exchange documents reliably, independent of software, hardware, or operating system. Invented by Adobe, PDF is now an open standard maintained by the International Organization for Standardization (ISO).
