Online Forms

Chicago Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

Fill Out Form Online



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Contact Us

Our Locations

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Hours

Homewood

Monday:

9:00 am-12:00 pm

3:00 PM-6:00 PM

Tuesday:

9:00 am-12:00 pm

3:00 pm-6:00 pm

Wednesday:

9:00 am-12:00 pm

Thursday:

9:00 am-12:00 pm

3:00 pm-6:00 pm

Friday:

9:00 am-12:00 pm

Saturday:

9:00 am-11:00 am

Sunday:

Closed

Libertyville

Monday:

9:00 am-12:00 pm

3:00 PM-6:00 PM

Tuesday:

Closed

Wednesday:

9:00 am-12:00 pm

3:00 PM-6:00 PM

Thursday:

Closed

Friday:

9:00 am-12:00 pm

Saturday:

Closed

Sunday:

Closed