Forms & documents
Fill it out at home, not in the waiting room
Download and complete your paperwork before you arrive so your appointment starts on time — and you spend your visit talking to your doctor instead of a clipboard.
Downloads
Patient forms
Print, complete and bring them with you — or email them ahead to info@wellmedcenters.com.
Medical services
Medical Services Documents
Registration FormNew-patient registration and intake
Medical History FormConditions, medications, allergies and family history
IV Infusion Consent FormConsent for intravenous infusion treatment
Opioid Medications Patient AgreementRequired agreement for opioid prescriptions
Consent for Release of Confidential InformationAuthorization to send or request records
Beauty & aesthetic
Beauty & Aesthetic Documents
Media Consent FormConsent for photo or video use
Botox Consent Form & After-Care InstructionsConsent and post-treatment care
Having trouble opening a form? Call 847-375-9711 and we'll email it to you directly.
Office policies
How we run the practice
Please give us as much notice as you can if you need to cancel or reschedule — ideally 24 hours. That lets us offer your slot to another patient who needs to be seen. Repeated missed appointments without notice may be subject to a fee.
Request refills through your pharmacy where possible, and allow two business days. Some medications require an office visit or recent lab work before they can be refilled.
We contact you about results once they've been reviewed by your clinician. If you haven't heard from us within the timeframe we gave you, please call — never assume no news is good news.
Your medical information is protected under HIPAA. We disclose it only as permitted by law or as you authorize in writing. Our full Notice of Privacy Practices is available above and at the front desk.
This website and our phone line are not for emergencies. If you are experiencing a medical emergency, call 911 or go to your nearest emergency department immediately.
We are committed to making our clinic and this website usable for everyone. If you encounter a barrier here or need an accommodation for your visit, call 847-375-9711 or email info@wellmedcenters.com and we'll make it right.
Emergency? Do not use this website or email. Call 911 or go to your nearest emergency department.
Paperwork done? Let's book you in.
Choose a time that works for you, or call and we'll find one together.