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Online Forms

1. Confidential Patient Health Record 

2. Chief Complaint 

3.  Recreational Activity Form 

4. Symptoms Form 

5.  Terms Of Acceptance

6. HIPAA

 

2504 Washington St. Ste 200B

Waukegan, IL 60085

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M: 9-11am, 3-7pm

T: 9-11am, 3-7pm

W: 9-11am, 3-7pm

Th: 9-11am, 3-7pm

Sat: By Apt

 

 

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Call: (224) 637-8335

 

                  

 

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